Effects of Health Insurance Among Patients on Hepatitis C Treatment Along the Texas-Mexico Border

Abstract

Introduction: The incidence of hepatitis C virus (HCV) infection is increasing along the U.S.-Mexico border and across the world. There are significant implications for patients who are non-funded and seeking treatment for hepatitis C that are faced by border communities. Having a disproportionate number of individuals without insurance and high rates of undocumented residents may influence treatment outcomes for HCV patients. The purpose of this project was to examine the effect of health insurance status and office visit compliance on sustained virologic response (SVR) in adult patients living along the Texas-Mexico border treated for HCV. Methods: We conducted a longitudinal retrospective chart review of patients who underwent treatment with dual and triple therapy in a border community in Texas. The sample included patients between the ages of 18 and 65, with a diagnosis of HCV, who underwent HCV treatment between January 01, 2010 and August 15, 2013, El Paso, Texas. Data were collected from the charts of patients who received HCV treatment with pegylated interferon, ribavirin, and a protease inhibitor. Results: A total of 76 charts were reviewed. Twenty patients met study criteria and were included in the data analysis. The other 56 (73%) patients did not complete treatment or did not return for SVR testing. Of the 20 patients who were included in the study, 19 (95%), were Hispanic, 12 (50%) were female, age included 11 (55%), age 20-29, 7 (35%), age 30-39, 2 (10%) age 40-49. Most patients were overweight with BMI 18-25 in 3 (15%), BMI 25-30 in 9 (45%), and BMI >30 in 8 (40%). Eleven patients were genotype 1, 4 were genotype 2, 5 were genotype 3. Of the 20 patients included in the study, 4 had insurance and 16 did not. Of the 16 patients who were non-funded, all 16 patients were on an indigent managed health care program. SVR was achieved in three-fourths (75%) of patients with insurance versus 12/16 (75%) without insurance (p=1.0). Gender, age, and HCV PCR baseline level did not show significant effects on SVR response using multiple logistic regression analysis. Conclusion: In conclusion, in this sample of HCV patients treated in a Texas-Mexico border community, insurance status did not affect SVR outcomes. Patients who did not have insurance, but were provided some type of assistance or managed care program, completed treatment and had high SVR rates. Disclosure - Roberta Romero DNP, RN, FNP-C has received honoraria from Genentech, Vertex, and Gilead Pharmaceuticals and is on the speaker’s bureau for Genentech and Gilead. Ogechika Alozie has received honoraria from Abbvie Pharmaceuticals and is on the speaker’s bureau for Abbvie and ViiV.