Challenges of hepatitis C treatment in Native Americans in two North Dakota medical facilities

Abstract

The prevalence of chronic liver disease (CLD) in the Aboriginal North American population is disproportionately higher than that of the non-indigenous population. Hepatitis C virus (HCV) is the second leading cause of CLD in American Indians or Alaska Natives (AIANs). This study described the experience of two teaching community medical centers in North Dakota in treating HCV infection among AIANs and compared treatment outcomes to a cohort of Caucasian patients. Methods: The retrospective study described the characteristics and proportion of AIAN patients with HCV who received treatment. Documented reasons for not receiving treatment were analyzed. For those AIAN patients treated for HCV infection, responses to treatment, including rapid, early and sustained virological responses (SVRs), were compared with those of Caucasians. Results: Only 22 (18%) of 124 AIANs with HCV infection received treatment. Common reasons for not receiving treatment include lack of access to specialists, concomitant or decompensated liver disease, alcohol and drug abuse and cost. There were no significant differences in the baseline characteristics and key predictors of SVR in AIANs compared to Caucasian controls. Conclusions: Most AIAN patients with HCV infection do not receive treatment despite comparable treatment response rates to Caucasians. Further population-based studies, addressing access to specialized hepatitis C treatment and public health concerns are warranted, as it is crucial to treat chronic HCV infection to decrease the burden of disease in the AIAN community.

Evaluation of treatment access and scope of a multistate hepatitis C virus Extension for Community Healthcare Outcomes telehealth service in the US Indian Health System, 2017‐2021

“…18 The ECHO model increases access to HCV care by addressing important previously identified barriers to HCV care, including the need for referral, transportation, travel costs, and lack of access to specialists. 12,26 Prior to the initiation of the Indian Country ECHO, a facility-based assessment of the Indian Health Service found only 8% of survey respondents provided HCV treatment at their facility and that most (69%) referred to a specialist for HCV treatment. 26 Barriers to getting HCV care from referrals were patient ineligibility for treatment due to active substance use, transportation, and cost.…”

“…32 Behavior change recommendations, such as weight loss, alcohol cessation, and tobacco cessation, have been shown to be helpful in slowing the rate of progression of liver disease. 21,33,34 While active substance use has been cited as a barrier to HCV treatment for some providers, 12,26,35 it was not a barrier to treatment for patients presented at Indian Country ECHO. One-third of patients received recommendations for substance use treatment inclusive of substance use evaluation and treatment, harm reduction information, and behavioral health referral.…”

“…Despite knowledge of HCV‐related morbidity and mortality in AI/AN persons, treatment rates remain low. A retrospective cohort study of HCV treatment initiation in AI/ANs in North Dakota showed that only 22 of 124 (18%) AI/AN persons with HCV received treatment 12 . Reasons for not receiving HCV treatment included lack of access to specialists, signs of advanced liver fibrosis, active substance use, and cost 12 .…”

“…A retrospective cohort study of HCV treatment initiation in AI/ANs in North Dakota showed that only 22 of 124 (18%) AI/AN persons with HCV received treatment. 12 Reasons for not receiving HCV treatment included lack of access to specialists, signs of advanced liver fibrosis, active substance use, and cost. 12 However, one limitation of this study is that it was published before the adoption of the second-generation DAAs for HCV treatment.…”

“…12 Reasons for not receiving HCV treatment included lack of access to specialists, signs of advanced liver fibrosis, active substance use, and cost. 12 However, one limitation of this study is that it was published before the adoption of the second-generation DAAs for HCV treatment. The primary health system for AI/AN persons is the Indian Health System, a network of facilities comprised of the Indian Health Service, Tribal, and Urban Indian organizations.…”