Abstract
Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is well tolerated, cost-effective, and yields high sustained virologic response rates, yet it has remained inaccessible to many patients due to cost. We evaluated the relationship between health insurance status and DAA initiation in an observational cohort of US women.
Women's Interagency HIV Study participants with HIV and HCV (RNA+) reporting no prior hepatitis C treatment were followed for DAA initiation (2015-2019). We estimated risk ratios (RRs) of the relationship between time-varying health insurance status and DAA initiation, adjusting for confounders with stabilized inverse probability weights. We also estimated weighted cumulative incidences of DAA initiation by health insurance status.
139 women (74% Black) were included; at baseline, median age was 55 and 86% were insured. Most had annual household incomes ≤$18,000 (85%); advanced liver fibrosis (21%), alcohol use (45%), and recreational drug use (35%) were common. Across 439 subsequent semiannual visits, 88 women (63%) reported DAA initiation. Compared to no health insurance, health insurance increased the likelihood of reporting DAA initiation at a given visit (RR, 4.94; 95% confidence limit [CL], 1.92-12.8). At two years, the weighted cumulative incidence of DAA initiation was higher among the insured (51.2%; 95% CL, 43.3%-60.6%) than the uninsured (3.5%; 95% CL, 0.8%-14.6%).
Accounting for financial, clinical, behavioral, and sociodemographic factors over time, health insurance had a substantial positive effect on DAA initiation. Interventions to increase insurance coverage should be prioritized to increase uptake of HCV curative therapy for persons with HIV.
