Abstract：
OBJECTIVE: Hepatitis C virus (HCV) care cascade data by race/ethnicity for US correctional populations are sparse.
OBJECTIVE: To evaluate the HCV care cascade by race/ethnicity for a state correctional population.
METHODS: This retrospective cohort study used Connecticut Department of Correction data for incarcerated individuals tested, diagnosed, and treated for chronic HCV infection with direct-acting antivirals (DAAs) from 2019 to 2023.
METHODS: HCV care cascade outcomes, including testing, treatment, and cure rates, were compared by race/ethnicity. Poisson regression was used to estimate prevalence ratios (PRs), with adjustment for demographic and legal status factors.
RESULTS: A total of 24,867 patients tested for HCV (88.9% men, mean (SD) age 35.6 (11.8), 32.7% White, 37.9% Black, 28.4% Hispanic, 0.6% Asian, 0.4% American Indian/Alaska Native (AIAN), 34.7% sentenced ≥ 1 year). Both HCV exposure and chronic HCV were highest for White (27.1% and 15.2%) and lowest for Black individuals (4.6% and 2.6%) (P < 0.01, for both outcomes). While incarcerated, 63.2% of chronic HCV patients started DAAs, and treatment rates did not significantly differ by race/ethnicity (P > 0.05). For those treated and having post-treatment lab data available, cure rates were 98.8% or better for all racial/ethnic groups (P > 0.05). In the adjusted regression analyses, HCV treatment initiation was lower for those sentenced < 1 year (PR, 0.76; 95% CI, 0.67-0.87) and unsentenced (PR, 0.85; 95% CI, 0.80-0.91) than those sentenced ≥ 1 year. The adjusted prevalence of advanced fibrosis stage/activity grade was not significantly associated with race/ethnicity.
CONCLUSIONS: In this cohort study, less than two-thirds of chronic HCV patients initiated DAA treatment during their incarceration, and for those with available data, nearly all were cured. While there were disparities in HCV exposure and chronic HCV infection, significant racial/ethnic differences were not observed for treatment initiation or cure rates. Further efforts are needed to increase HCV treatment, especially for patients with shorter incarceration periods.
OBJECTIVE: To evaluate the HCV care cascade by race/ethnicity for a state correctional population.
METHODS: This retrospective cohort study used Connecticut Department of Correction data for incarcerated individuals tested, diagnosed, and treated for chronic HCV infection with direct-acting antivirals (DAAs) from 2019 to 2023.
METHODS: HCV care cascade outcomes, including testing, treatment, and cure rates, were compared by race/ethnicity. Poisson regression was used to estimate prevalence ratios (PRs), with adjustment for demographic and legal status factors.
RESULTS: A total of 24,867 patients tested for HCV (88.9% men, mean (SD) age 35.6 (11.8), 32.7% White, 37.9% Black, 28.4% Hispanic, 0.6% Asian, 0.4% American Indian/Alaska Native (AIAN), 34.7% sentenced ≥ 1 year). Both HCV exposure and chronic HCV were highest for White (27.1% and 15.2%) and lowest for Black individuals (4.6% and 2.6%) (P < 0.01, for both outcomes). While incarcerated, 63.2% of chronic HCV patients started DAAs, and treatment rates did not significantly differ by race/ethnicity (P > 0.05). For those treated and having post-treatment lab data available, cure rates were 98.8% or better for all racial/ethnic groups (P > 0.05). In the adjusted regression analyses, HCV treatment initiation was lower for those sentenced < 1 year (PR, 0.76; 95% CI, 0.67-0.87) and unsentenced (PR, 0.85; 95% CI, 0.80-0.91) than those sentenced ≥ 1 year. The adjusted prevalence of advanced fibrosis stage/activity grade was not significantly associated with race/ethnicity.
CONCLUSIONS: In this cohort study, less than two-thirds of chronic HCV patients initiated DAA treatment during their incarceration, and for those with available data, nearly all were cured. While there were disparities in HCV exposure and chronic HCV infection, significant racial/ethnic differences were not observed for treatment initiation or cure rates. Further efforts are needed to increase HCV treatment, especially for patients with shorter incarceration periods.
摘要：
目标：美国矫正人群按种族/民族划分的丙型肝炎病毒（HCV）护理级联数据很少。
目的：以种族/民族评估国家矫正人群的HCV护理级联。
方法：这项回顾性队列研究使用了康涅狄格州矫正部门的数据，诊断，并在2019年至2023年期间使用直接作用抗病毒药物（DAAs）治疗慢性HCV感染。
方法：HCV护理级联结果，包括测试，治疗,和治愈率，按种族/民族进行比较。泊松回归用于估计患病率比率(PRs)，调整人口和法律地位因素。
结果：共有24,867名患者进行了HCV检测（男性占88.9％，平均（SD）年龄35.6（11.8），32.7%白色,37.9%黑色,28.4%的西班牙裔，0.6%亚洲人，0.4%美洲印第安人/阿拉斯加原住民(AIAN)，34.7%被判刑≥1年)。HCV暴露和慢性HCV在白人中最高（27.1％和15.2％），在黑人个体中最低（4.6％和2.6％）（P<0.01，对于两种结果）。在被监禁期间，63.2％的慢性HCV患者开始DAA，不同种族/民族的治疗率无显著差异(P>0.05)。对于那些接受治疗并有治疗后实验室数据的人，所有种族/民族的治愈率均为98.8％或更高（P>0.05）。在调整后的回归分析中，对于那些被判刑<1年的人，丙肝治疗的开始率较低(PR，0.76；95%CI，0.67-0.87）和未判刑（PR，0.85；95%CI，0.80-0.91)比被判刑≥1年的人。调整后的晚期纤维化分期/活动度的患病率与种族/民族无关。
结论：在这项队列研究中，不到三分之二的慢性HCV患者在监禁期间开始DAA治疗，对于那些有可用数据的人来说，几乎都被治愈了。虽然在HCV暴露和慢性HCV感染方面存在差异，未观察到治疗开始率或治愈率的显著种族/民族差异.需要进一步努力增加HCV治疗，特别是对于监禁期较短的患者。
目的：以种族/民族评估国家矫正人群的HCV护理级联。
方法：这项回顾性队列研究使用了康涅狄格州矫正部门的数据，诊断，并在2019年至2023年期间使用直接作用抗病毒药物（DAAs）治疗慢性HCV感染。
方法：HCV护理级联结果，包括测试，治疗,和治愈率，按种族/民族进行比较。泊松回归用于估计患病率比率(PRs)，调整人口和法律地位因素。
结果：共有24,867名患者进行了HCV检测（男性占88.9％，平均（SD）年龄35.6（11.8），32.7%白色,37.9%黑色,28.4%的西班牙裔，0.6%亚洲人，0.4%美洲印第安人/阿拉斯加原住民(AIAN)，34.7%被判刑≥1年)。HCV暴露和慢性HCV在白人中最高（27.1％和15.2％），在黑人个体中最低（4.6％和2.6％）（P<0.01，对于两种结果）。在被监禁期间，63.2％的慢性HCV患者开始DAA，不同种族/民族的治疗率无显著差异(P>0.05)。对于那些接受治疗并有治疗后实验室数据的人，所有种族/民族的治愈率均为98.8％或更高（P>0.05）。在调整后的回归分析中，对于那些被判刑<1年的人，丙肝治疗的开始率较低(PR，0.76；95%CI，0.67-0.87）和未判刑（PR，0.85；95%CI，0.80-0.91)比被判刑≥1年的人。调整后的晚期纤维化分期/活动度的患病率与种族/民族无关。
结论：在这项队列研究中，不到三分之二的慢性HCV患者在监禁期间开始DAA治疗，对于那些有可用数据的人来说，几乎都被治愈了。虽然在HCV暴露和慢性HCV感染方面存在差异，未观察到治疗开始率或治愈率的显著种族/民族差异.需要进一步努力增加HCV治疗，特别是对于监禁期较短的患者。
