Gaps Observed in Hepatitis C Care Among Those Born Between 1945-1965

Stethoscope, syringe, doctor
Stethoscope, syringe, doctor
There is still a significant gap in the initiating treatment step of the hepatitis C care cascade in the United States.

Although linkage to care was shown to be largely successful in the Birth-Cohort Evaluation to Advance Screening and Testing of Hepatitis C (BEST-C) study, the largest gap in hepatitis C care was seen in treatment initiation, according to research published in the American Journal of Managed Care.

Researchers in the current study sought to estimate the attainment of hepatitis C care cascade steps for patients newly diagnosed as antibody-positive by conducting chart reviews of patients at 3 medical centers participating in the BEST-C study.

They defined care cascade steps as a positive antibody test, a confirmatory genotype or RNA test, receipt of positive result, clinical evaluation concurrently or subsequently to receipt of positive test results, initiation of antiviral therapy, treatment completion, and undetectable viral load within 2 weeks of end of treatment.

Study participants were born between 1945 and 1965 and were diagnosed with hepatitis C between December 2012 and October 2015 (N=130). Researchers tracked these patients’ receipt of genotype or RNA testing, clinical evaluation, treatment initiation, and completion of treatment.

Of the 130 total patients with hepatitis C, 91% (n=118) had a genotype or RNA test, 58% (n=75) were RNA-positive, 56% (n=73) were linked to hepatitis C care, 17% (n=22; 29% of RNA-positive patients) started treatment, and 16% (n=21; 28% of RNA-positive patients) completed treatment.

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The study investigators conclude that whereas linkage to care was largely successful, there was still a significant gap in the initiating treatment step of the hepatitis C care cascade, and therefore, “greater emphasis on linking patients to clinical evaluation and treatment is necessary in order to achieve the public health benefits promised by birth-cohort testing.”


Brady JE, Vellozzi C, Hariri S, et al. Hepatitis C care cascade among persons born 1945-1965: 3 medical centersAm J Manag Care. 2018 Sep;24(9):421-427.