NYC Health Department Surveillance Study: Barriers to Hep C Treatment Among NYC Residents

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1 NYC Health Department Surveillance Study: Barriers to Hep C Treatment Among NYC Residents Andrea V. King, MPH New York City Department of Health and Mental Hygiene

2 GOALS OF OUR STUDY To describe clinical and social factors related to treatment initiation among New York City residents with chronic hepatitis C virus (HCV) among those most likely to be considering HCV treatment by collecting information from patients and medical providers To assess reasons these patients may not receive antiviral treatment. 2

3 Sample 300 Excluded 92 Infected 208 Interviewed Patients 91 3

4 CHARACTERISTICS OF UNCURED PATIENTS N % Total % Sex Male % Female 70 34% Age Birth Cohort ( ) % Other 50 24% Insurance Medicaid % Private 51 25% Medicare 14 7% Medicaid and Medicare 14 7% Other 2 1% None 6 3% Unknown / Unspecified 19 9% Provider Discussed HCV Treatment with Patient Yes % No 47 23% Unknown 8 4% Genotype 1a or 1b % 3 or 3a 13 6% 2a or 2b 6 3% Other 4 2% Unknown 32 15% 45 of 153 (29%) plan to start treatment soon 4

5 Provider reports Patient self-reports Barrier to hepatitis C treatment (179 patients) (89 patients) Comorbid condition 41% 34% Currently drinks alcohol or uses drugs 24% 3% Medical condition 21% 19% Mental health issue 19% 12% Not keeping follow-up or referral appointments 2 28% NA 3 Provider does not prescribe HCV medications, refers for treatment 4 22% NA 3 Concern over side effects 14% 29% Don t feel sick NA 5 24% Waiting for better treatment regimen 13% 17% Concerns over cost or insurance problems 4% 13% Too many responsibilities NA 5 8% History of non-adherence to medications 8% NA 3 Disease not advanced enough 6% 7% "No barriers to treatment" 2 6% 11% 1 This table summarizes barriers reported by >5% of patients or providers. Categories are not mutually exclusive. 58% of providers reported more than one barrier for their patients, and 41% of patients reported more than one barrier. 2 Received as a write-in response from providers and standardized for inclusion in this table. All other responses were selected from a checklist. 3 Not asked of patients 4 72 the 179 providers (40%) were primary care/internal medicine doctors. 63% of affirmative responses for this barrier were from primary care/internal medicine providers. 5 Not asked of providers REASONS FOR NOT INITIATING HCV TREATMENT 5

6 CHALLENGES FACED BY PATIENTS I don t want to be guinea pig for the new medication. I m scared about the side effects of treatments. I got referred to Hospital X but missed the appointment because I had to pick my daughter up from school My insurance denied my request to start treatment because my liver damage has not progressed far enough. I don t feel comfortable with my primary care provider. My doctor keeps on pushing me to get another liver biopsy and I don t want to do it. Also, he keeps pushing me to go to a GI specialist that I don t like. The pills are too expensive. My daughter has Hep C too, and I don t think she ll be covered. I don t want to get cured if she can t get cured too.

7 ADDRESSING BARRIERS Barrier Comorbid condition Currently drinks alcohol or uses drugs Medical condition Mental health issue Not keeping follow-up or referral appointments Provider does not prescribe HCV meds, refers for treatment Concern over side effects Not feeling sick Possible Solutions Educate clinicians about new regimens and that patients with comorbid conditions can complete these treatments Patient navigation and linkage to care interventions Care coordination Use of text messaging and other technology Educate primary care physicians to begin treating patients Linkage to care programs at primary care practices Educate patients and providers about the improved side effect profiles for new regimens Educate patients about the importance of monitoring liver health 7

8 ADDRESSING BARRIERS Barrier Concerns over cost or insurance issues Too many responsibilities History of non-adherence to medications Insurance companies require advanced disease to pay for treatment Possible Solutions Patient assistance programs Advocacy Care coordination and health promotion Advocacy and policy Appeal insurance denials 8

9 ACKNOWLEDGEMENTS Thanks to everyone who provided expertise and hard work to make this project possible. Jennifer Baumgartner Katherine Bornschlegel Fabienne Laraque Muhammad Iftekharuddin Nirah Johnson Perminder Khosa Emily McGibbon Noelisa Montero Miranda Moore Jay Varma Janette Yung Wei Wei Zhang BCD Data Unit Annie Fine Ana Maria Fireteanu Kristen Forney Sharon Greene Natasha McIntosh Eric Peterson Alaina Stoute