Barriers in Hepatitis C Treatment in Somali Patients in the Direct Acting Antiviral Therapy Era

Saleh Elwir; Chimaobi Anugwom; Esther K Connor; Nasra H Giama; Albert Ndzengue; Jeremiah Menk; Essa A Mohamed; Lewis R Roberts; Mohamed Hassan

doi:10.1016/j.jnma.2018.02.002

Barriers in Hepatitis C Treatment in Somali Patients in the Direct Acting Antiviral Therapy Era

J Natl Med Assoc. 2018 Dec;110(6):556-559. doi: 10.1016/j.jnma.2018.02.002. Epub 2018 Mar 10.

Authors

Saleh Elwir¹, Chimaobi Anugwom², Esther K Connor², Nasra H Giama³, Albert Ndzengue³, Jeremiah Menk⁴, Essa A Mohamed⁵, Lewis R Roberts³, Mohamed Hassan²

Affiliations

¹ Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA; Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA. Electronic address: saleh.elwir@bswhealth.org.
² Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA.
³ Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
⁴ Clinical and Translational Science, University of Minnesota, Minneapolis, MN, USA.
⁵ Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA; Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA.

PMID: 30129499
DOI: 10.1016/j.jnma.2018.02.002

Abstract

Background and aims: Hepatitis C virus (HCV) treatment has changed dramatically in the last few years. Our observations suggest that a minority of HCV infected Somalis are treated. In this study, we aimed to evaluate for treatment and health outcome disparities between Somali and non-Somali patients during the direct acting antiviral (DAA) era.

Methods: Patients with HCV seen in the gastroenterology clinic in 2015 were included in the study. Patients were identified using ICD9 and 10 codes. Electronic medical records were analyzed to evaluate for treatment candidacy, acceptance and reasons for refusal of treatment.

Results: Genotype 4 followed by 3 were the most common genotypes in the Somalis while genotype 1 was the most common in the non-Somalis. Majority of patients were offered treatment, active alcohol and substance abuse was a common reason for not offering treatment in non-Somalis while the presence of hepatocellular carcinoma was the most common reason in Somalis. Somalis had higher rates of declining treatment given the asymptomatic nature of their disease and the feeling that treatment is not needed. Sustained virologic response rates were comparable in both groups.

Conclusions: Disparities in acceptance of HCV treatment persist in the DAA era. The asymptomatic nature of the infection and potential cultural mistrust makes patients hesitant to undergo treatment. Healthcare providers must find interventions aimed at reducing barriers to treatment and increasing acceptance of HCV treatment.

Keywords: Health Disparity; Hepatitis C; Somali.

MeSH terms

Antiviral Agents / therapeutic use*
Asymptomatic Infections / therapy
Female
Genotype
Hepacivirus / genetics
Hepatitis C, Chronic / drug therapy*
Hepatitis C, Chronic / ethnology
Humans
Insurance Coverage / statistics & numerical data*
Insurance, Health / statistics & numerical data*
Male
Minnesota
Patient Acceptance of Health Care*
Patient Selection*
Somalia / ethnology
Sustained Virologic Response
Treatment Refusal
Trust

Substances

Antiviral Agents