941 Sex-Specific and Ethnicity-Specific Disparities in Successful Linkage to Care Among Chronic Hepatitis C Virus Infection Patients at a Under-Served Safety Net Hospital

Abstract

INTRODUCTION: Despite availability of highly effective therapies for chronic hepatitis C virus (HCV), sub-optimal linkage to care (LTC) after HCV diagnosis remains a major barrier to achieving eradication. We aim to identify sex- and ethnicity-specific disparities in HCV LTC among an ethnically diverse safety-net population. METHODS: We retrospectively evaluated all adults who underwent HCV antibody (Ab) testing at a single-center safety-net hospital from 2014 to 2018. Among adults with positive HCV Ab, we evaluated overall rates and trends in proportion of patients with positive HCV RNA. Rates of chronic HCV infection were compared by sex and race/ethnicity using chi-squared methods. Among patients with confirmed chronic HCV infection, we evaluated overall rates and trends in successful LTC (defined as successful completion of first medical encounter with a HCV provider following diagnosis). Comparisons of successful LTC between groups were evaluated with chi-squared testing and adjusted multivariate logistic regression models. RESULTS: From 2014 to 2018, 54,173 HCV Ab tests were performed, among which 7.03% were HCV Ab positive. Among patients with HCV Ab positive, prevalence of positive HCV RNA was 52.5%. From 2014 to 2018, proportion of HCV Ab positive patients with positive HCV RNA declined from 74.3% in 2014 to 44.2% in 2018. The prevalence of HCV RNA positive among HCV Ab positive patients was significantly higher in men compared to women (58.0% vs. 43.7%, P < 0.001), significantly higher in African Americans compared to whites (58.8% vs. 52.7%, P < 0.001), and significantly lower in Asians compared to whites (30.4% vs. 52.7%, P < 0.001). Overall LTC among patients with confirmed chronic HCV infection was 33.2%. Women with chronic HCV had significantly higher LTC compared to men (38.3% vs. 30.6%, P < 0.04). Compared to whites with chronic HCV, significantly higher LTC rates were observed for African Americans (33.3% vs. 27.4%, P < 0.01) and Asians (66.7% vs. 27.4%, P < 0.01). On multivariate regression, there was a trend towards lower LTC rates among men compared to women (OR 0.73, 95% CI 0.52-1.02, P = 0.06). Asians were significantly more likely to achieve successful LTC compared to whites (OR 3.80, 95% CI 1.40-10.32, P < 0.01). CONCLUSION: Among safety-net populations with HCV, sex-specific and ethnicity-specific disparities in successful LTC were observed. Successful LTC following HCV diagnosis was highest among women, African Americans, and Asians.