Background Among the 1.2 million people with human immunodeficiency virus (HIV) in the United States, 25% are coinfected with hepatitis C virus (HCV). The availability of effective direct acting antivirals (DAAs) makes the goal of HCV elimination feasible, but implementation requires improvements to the HCV treatment cascade, especially linkage to and initiation of treatment in underserved populations. Methods In this retrospective review, a cohort of patients receiving care at a hospital-based HIV clinic in New Haven, Connecticut (January 1, 2014–March 31, 2017) with chronic HCV infection not previously treated with DAAs were followed longitudinally. Patients were referred to a colocated multidisciplinary team. Standardized referral and treatment algorithms and electronic medical record templates were developed, monthly meetings were held, and a registry was created to review progress. Results Of 173 patients, 140 (80.9%) were 50–70 years old, 115 (66.5%) were male, 99 (57.2%) were African American, 43 (24.9%) were white, and 23 (13.3%) were Hispanic. Comorbidities included the following: cirrhosis (25.4%), kidney disease (17.3%), mental health issues (60.7%), alcohol abuse (30.6%), and active drug use (54.3%). Overall, 161 (93.1%) were referred, 147 (85%) were linked, 122 (70.5%) were prescribed DAAs, and 97 (56.1%) had sustained viral response at 12 weeks posttreatment or cure (SVR12). Comparison between those with SVR12 and those unsuccessfully referred, linked, or treated, showed that among those not engaged in HCV care, there was a higher proportion of younger (mean age 54.2 vs 57 years old, P = .022), female patients (P = .001) and a higher frequency of missed appointments. Conclusions Establishing a colocated HCV clinic within an HIV clinic resulted in treatment initiation in 70.5% of patients and SVR12 in 56.1%. This success in a hard-to-treat population is a model for achieving microelimination goals set by the World Health Organization.

Objectives Hydroxychloroquine (HCQ) is a key therapy in systemic lupus erythematosus (SLE). Medication non-adherence is reported in up to 80% of lupus patients and results in increased morbidity, mortality, and health care utilization. HCQ levels are a sensitive and reliable method to assess medication adherence. Our study evaluated the role of HCQ level measurement in routine clinical care and its association with disease activity in a predominantly Hispanic population. Methods SLE patients from the Columbia University Lupus cohort treated with HCQ for ≥ 6 months and reporting medication adherence were included. HCQ levels were measured by whole blood high performance liquid chromatography. Non-adherence was defined as an HCQ level <500 ng/ml. The association between HCQ levels and disease activity measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was evaluated. Results One hundred and eight patients were enrolled; the median age was 38 years, 91% were female, and 63% were Hispanic. The median SLEDAI-2K was 4.3 (0–20). Forty-one percent of patients had an HCQ level <500 ng/ml consistent with non-adherence, of which 19% had undetectable levels. A higher SLEDAI-2K score was associated with low HCQ levels ( p = 0.003). This association remained significant after adjusting for depression ( p = 0.0007). Conclusion HCQ levels < 500 ng/ml were associated with higher disease activity and accounted for 32% of the SLEDAI-2K variability. HCQ blood measurement is a simple and reliable method to evaluate medication adherence in SLE. Reasons for non-adherence (levels < 500 ng/ml) should be further explored and addressed.