Women living with HIV who have health insurance are much more likely to start direct-acting antiviral therapy for hepatitis C than those who do not have insurance, but those covered by Medicaid are less likely to initiate treatment than those with private insurance, according to study findings published in Clinical Infectious Diseases.
While direct-acting antivirals (DAAs) are highly effective for treating chronic hepatitis C virus (HCV) infection, they can be expensive and thus unattainable for some individuals.
Andrew Edmonds, PhD, of the University of North Carolina Gillings School of Public Health, and colleagues analyzed the potential association between health insurance and initiation of antiviral therapy by women with both HIV and HCV in the Women’s Interagency HIV Study.
Between 2015 and 2019, the team assessed 139 women who had not previously been treated for hepatitis C. A majority (74%) were Black, and the average age was 55 years. About one in five had advanced liver fibrosis, 45% consumed alcohol and 35% used recreational drugs. Some 85% had an annual household income of at least $18,000. Most (86%) had some type of health insurance, and among those insured, 87% had Medicaid coverage.
Over the course of the study, 88 women (63%) started antiviral therapy for hepatitis C. Women who had health insurance were nearly five times more likely to report direct-acting antiviral initiation at any given visit compared with those who did not have insurance. After two years of follow-up, the likelihood of antiviral therapy initiation was substantially higher in insured women (51%) compared with those who were uninsured (4%). While women on Medicaid were more likely to start HCV treatment than those with no insurance, those with other types of insurance—such as private plans—were even more likely.
“Accounting for clinical, behavioral and sociodemographic factors over time, health insurance had a substantial positive effect on DAA initiation,” wrote the researchers. “Interventions to increase insurance coverage should be prioritized to increase HCV curative therapy uptake for persons with HIV.”
These findings suggest that increasing state Medicaid coverage helps more people access hepatitis C treatment, and the ongoing roll-back of expanded Medicaid coverage since the end of the COVID-19 emergency could have a detrimental effect.
Click here to read the study in Clinical Infectious Diseases.
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