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HCV Cascade/Denver - Impact of Interferon-Era HCV Treatment
Restrictions on Current Referral and Treatment Trends
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Reported by Jules Levin
IDSA 2015 Oct 7-11 San Diego, CA
Larissa Muething, MD, Edward M. Gardner, MD, Rebecca Hanratty, MD, Aimee Truesdale, MD, Sarah E. Rowan, MD
From January 7, 2013 -November 3, 2014, 250 individuals were newly diagnosed with chronic HCV (RNA+)
· 101 (40%) female, 149 (60%) male, 149 (60%) African American, 50 (20%) white non-Hispanic, 48 (18%) Hispanic
· 82 (32%) were referred to specialty clinic
· The most common reasons for not referring were substance abuse and comorbid medical disease (Figure 1)
· Individuals with substance abuse were less likely to be referred (p<0.005), but if referred were equally likely to attend (p=0.2) an HCV specialty visit (Figure 2)
· Most common reason for not treating was lack of advanced disease
· If all restrictions to referral (comorbid medical disease, mental illness, and substance abuse) were eliminated, 94 additional individuals could have been referred (56% of those not referred) (Figure 3)
·Although there was no difference in frequency of comorbid medical disease or mental illness between individuals who were referred and not referred, these reasons were commonly cited as reasons for not referring to HCV specialty clinic
· Individuals referred to HCV specialty clinic were significantly less likely to have active substance use disorders
·There was no difference in cirrhosis/high grade fibrosis (FIB-4 >3.25) between those referred and not referred
·Referral to specialty clinic was not documented in over 1/4 of patients suggesting a need for renewed HCV emphasis in the primary care setting
·Historical barriers to HCV treatment were less likely to be cited as reasons for not treating than were lack of advanced disease or loss to follow-up, suggesting that historical barriers to treatment should not be utilized as referral criteria to HCV specialty clinic
·Limitations include using chart review as sole source of provider reasoning and relatively short follow-up time period.
·As interferon-free treatment becomes more readily available, eliminating historic referral and treatment restrictions could significantly increase rates of HCV treatment
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