Lin M, et al. - This study was performed to investigate the barriers to hepatitis C treatment in the era of direct-acting anti-virals (DAA). In the DAA era, 50% of the patients with established hepatitis C virus (HCV) care were followed-up and only 29% received DAAs. Targeted efforts focusing on patient and system-levels could improve the reach of treatment with the new DAAs.

• In order to investigate predictors of follow-up in HCV clinics and DAA treatment, the researchers used clinical data from a retrospective cohort of HCV-infected patients with previously established HCV care in the US Department of Veterans Affairs (during 12/1/2013-4/30/2015).
• Then, they conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow-up and treatment.

• In this study, the researchers identified 84221 veterans who were previously seen in HCV clinics during the pre-DAA era.
• 47165 (56.0%) followed-up in HCV specialty clinics among them.
• Of whom, 13532 (28.7%) received DAAs.
• Predictors of follow-up were older age, prior treatment, presence of cirrhosis or HCC, HIV/HBV co-infection and psychiatric illness.
• Predictors of lack of treatment were alcohol/drug abuse and medical co-morbidity.
• 56.2% patients had a specialist visit and 28% received DAAs among the 905 prospectively recruited patients.
• Relocation (n = 148, 37.4%) and missed/cancelled appointments (n = 63, 15.9%) were common reasons for lack of follow-up.
• Waiting for newer therapy (n = 99, 38.8%), co-morbidities (n = 66, 25.9%) and alcohol/drug abuse (n = 63, 24.7%) were included as the reasons for lack of treatment.