Year of Publication

2017

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Steven Fleming, PhD

Committee Member

Bin Huang, DrPH

Committee Member

Wayne Sanderson, PhD

Abstract

Background: New generation Direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C infection have been on the market for more than 3 years since late 2013. Whether these medications cure patients at the rates claimed in clinical trials is not clear. Furthermore, as compliance is known to affect treatment outcomes, DAAs compliance rate is worth studying.

Methods: We analyzed the association of social-demographic, DAA use, enrollment with Kentucky Medicaid Managed Care Organizations (MCOs) and comorbidities, and DAA compliance in 1128 Kentucky Medicaid members treated with DAAs between August 07, 2014 and August 06, 2016.

Results: Age, MCOs, liver fibrosis or cirrhosis, the use of ribavirin as supportive treatment of DAAs and taking more than one DAA were significant determinants of patient compliance. Age above 60 and being enrolled with Wellcare were associated with an increase in hepatitis C medications adherence after adjusting for all other risk factors (1.434 [1.045, 1.968] for age > = 60 in comparison to age between 50-59, 0.58 [95% CI: (0.37, 0.89)], 0.35 [95% CI: (0.21, 0.58)], 0.64 [95% CI: (0.42, 0.99)] and 0.55 [95% CI: (0.40, 0.76)] respectively for Aetna, Anthem, Humana and Passport compared with Wellcare). In contrast, being comorbid with liver fibrosis/cirrhosis, taking ribavirin or more than one DAA were significantly related to decreased adherence (0.74 [0.57, 0.96], 61.6% [0.26, 0.58], 0.50 [0.29, 0.86 respectively]. Use of Sovaldi and being comorbid with rheumatoid arthritis also had an impact without achieving significance.

Conclusion: The findings of this study can be a useful screening tool for patients with factors that have predispositions for noncompliance. However, more studies in this area should be done to endorse these findings before they can be translated into clinical practice.

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