Lack of health insurance limits the benefits of Hepatitis C virus screening: Insights from the national health and nutrition examination Hepatitis C follow-up study

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Lack of health insurance limits the benefits of Hepatitis C virus screening: Insights from the national health and nutrition examination Hepatitis C follow-up study

Authors

Ditah, I.,Al Bawardy, B.,Gonzalez, H. C.,Saberi, B.,Ditah, C.,Kamath, P. S.,Charlton, M.

Citation
2015
American Journal of Gastroenterology

110

8
1126-1133
Type
Retrospective cohort
Virus targets
Hepatitis C
Interventions
HCV testing and linkage to Care
Linkage to care
Screening and diagnosis
Testing
Setting
National
Target populations
General Population
Country of development
United States of America
Target location
United States of America
DOI
10.1038/ajg.2015.31
Testing strategy
Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test
Laboratory-based antibody test
Laboratory-based PCR/RNA (confirmatory) test
Countries of included studies
United States of America

Health outcomes

Receipt of antibody results,Number new diagnoses,Linkage to care,Loss to follow-up cascade

Testing strategy

Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test

Abstract

OBJECTIVES: Identifying barriers to access to hepatitis C virus (HCV) treatment among screen detected subjects is critical for any public health strategy aimed at controlling HCV infection in the general population. METHOD(S): Data from the National Health and Nutrition Examination Survey HCV Follow-up study from 2001 to 2010 were used. Participants who tested positive for HCV were sent a letter informing them of their test results and advised to pursue further evaluation. Information on HCV transmission and its potential complications was also provided to all positive participants. These subjects were recontacted 6 months after notification to determine what action they had taken regarding the positive result. RESULT(S): Of 38,025 participants, 502 tested positive for HCV infection, giving a prevalence of 1.3% (95% confidence interval (CI) 0.8%, 1.8%). A total of 205 subjects participated in the 6-month follow-up interview. Those who could not be reached were more likely to be less educated, injecting drugs, and not to have health insurance. Half (50.2%) of the positive individuals were not aware of their status before notification. A total of 166 (81%) had pursued further evaluation. Only 18 (26.9%) received therapy. The main reason for not receiving treatment was high cost (19.4%). In adjusted analysis, the only barrier to pursuing downstream HCV care was the lack of health insurance (2.76, 95% CI 1.54, 7.69; P=0.007). CONCLUSION(S): This study suggests that the lack of health insurance may attenuate the theoretical benefits of a screening program that identifies asymptomatic HCV-infected individuals who are less likely to pursue downstream care.

Page updated

22 Jan 2021