Linkage to Care Influenced by Sex and Ethnicity of HCV Patients

Chantal Gomes, DO

While there are highly effective therapies to treat chronic hepatitis C virus (HCV), there is also sub-optimal linkage to care (LTC) following a diagnosis that could be preventing the virus from being eradicated.

In research presented at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019), a team of investigators, led by Chantal Gomes, DO, Department of Internal Medicine at Highland Hospital, identified sex and ethnicity specific disparities in HCV linkage to care among an ethnically diverse safety-net population.

In the study, the team retrospectively evaluated all adults who underwent HCV antibody testing at a single center safety-net hospital from 2014-2018. They then evaluated overall rates and trends in patients with positive HCV RNA in the adults with positive HCV antibodies included in the study.

They also used squared methods to identify and compare the chronic HCV infection rates by sex and race/ethnicity.

“Among safety-net populations with HCV, sex-specific and ethnicity-specific disparities in successful LTC were observed,” the authors wrote. “Successful LTC following HCV diagnosis was highest among women, African Americans, and Asians.”

The team evaluated overall rates and trends in successful linkage to care—defined as successful completion of first medical encounter with a HCV provider following a diagnosis of a chronic HCV infection.

Using chi-squared testing and adjusted multivariate logistic regression models, they compared and evaluated successful linkage to care between the different groups.

Between 2014-2018, 54,173 HCV antibody tests were performed, 7.03% of which were HCV antibody positive. Among this patient population, the prevalence of positive HCV RNA was 52.5%.

Trends was also seen based on sex and race/ethnicity in the prevalence of HCV RNA.

“The prevalence of HCV RNA positive among HCV [antibody] positive patients was significantly higher in men compared to women (58.0% vs. 43.7%, P < .001), significantly higher in African Americans compared to whites (58.8% vs. 52.7%, P <.001), and significantly lower in Asians compared to whites (30.4% vs. 52.7%, P <.001),” the authors wrote.

Similar trends were found along the same demographical lines for linkage to care rates.

“Compared to whites with chronic HCV, significantly higher LTC rates were observed for African Americans (33.3% vs. 27.4%, P <.01) and Asians (66.7% vs. 27.4%, P <.01),” the authors wrote. “On multivariate regression, there was a trend towards lower LTC rates among men compared to women (OR, .73, 95% CI, .52-1.02, P =.06). Asians were significantly more likely to achieve successful LTC compared to whites (OR 3.80; 95% CI, 1.40-10.32; P <.01).”

Overall, linkage to care among patients with diagnosed and confirmed chronic HCV infections was 33.2% and women with chronic HCV had a significantly higher linkage to care compared to men (38.3% vs. 30.6%, P <.04).

The presentation, “Sex-Specific and Ethnicity-Specific Disparities in Successful Linkage to Care Among Chronic Hepatitis C Virus Infection Patients at an Under-Served Safety Net Hospital,” was presented Monday, October 28, 2019, at the American College of Gastroenterology Annual Scientific Meeting (ACG 2019) in San Antonio, Texas.