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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3128 — Racial Disparities in the Initiation of Hepatitis C Antiviral Therapy

Zickmund SL, VA Pittsburgh Healthcare System, CHERP, University of Pittsburgh; Hanusa BV, and Obrosky DS, CHERP; Chapko MK, Northwest Center for Outcomes Research in older Adults, VA Puget Sound; Bayliss NK, CHERP; Switzer GE, and Sevick MA, CHERP & University of Pittsburgh; Zook CL, and Mrvka AJ, CHERP; Arnold RA, University of Pittsburgh

The hepatitis C virus infection (HCV) disproportionally affects African American (AA) Veterans; however, fewer AAs receive antiviral treatment. We prospectively followed patients diagnosed with HCV to identify potential racial differences during the evaluation process and initiation of treatment.

Patients with HCV scheduled for a Gastroenterology (GI) consultation at the VA Pittsburgh Healthcare System were tracked prospectively, via medical records, for 18 months following their GI consultation. GI, primary care, and mental health/substance use records were assessed to document interest in treatment, reasons for loss to follow-up in the GI clinic, medical, mental health, and substance use exclusions. The primary outcome variable was treatment initiation.

From December 2006 to March 2009, 688 Veterans were referred to GI to discuss HCV treatment. Of these, 575 (84%) attended their initial GI appointment. No significant racial differences were found in the initial interest in treatment (17% for whites; 14% for AA) or in exclusions for substance use (55% for white; 57% for AA). Of the 444 who moved on to initiating clinical tests and clearances, AAs were medically excluded at a higher rate (149/187 = 80%) than whites (174/257 = 68%, Chi-sq = 7.83, p = 0.005). Among the 112 Veterans deemed eligible for treatment, 57 patients did not return for follow-up visits and did not begin antiviral treatment (whites: 34/82 = 41%; AA: 23/38 = 62%). A total of 62 patients initiated treatment (11% of the initial 575), with more whites initiating therapy (48/82 = 58%) than AAs (14/38 = 37%; chi-sq = 4.38, p = 0.04).

Despite intense screening efforts, treatment initiation rates for HCV remain low in general and especially low for AA Veterans. Only roughly half of the eligible patients initiated treatment. While differences in medical exclusions explain some of the racial disparities, more AAs than whites dropped out of the process before treatment initiation, suggesting a differential effect of barriers.

This is the first study showing persist racial differences during the evaluation for and initiation of treatment for HCV, including in those deemed eligible. More detailed qualitative assessments of patient experiences are needed, which will enable us to more effectively treat this chronic illness.

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