Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States.

Abstract

BACKGROUND AND OBJECTIVES Pediatric HCV cases have increased in the United States. Guidelines recommend beginning treatment of HCV for children as young as 3 years old. However, no studies have evaluated pediatric linkage to HCV care and direct-acting antiviral (DAA) uptake on a national level. This study aims to characterize the HCV care cascade among a national cohort of children with HCV. METHODS This retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. We analyzed TriNetX Research Network data, a US national electronic health records network. Primary HCV care cascade outcomes included the number of children diagnosed with HCV infection, linked to care, and prescribed DAAs. We assessed the association between race and ethnicity with linkage to care using logistic regression. RESULTS Among 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA. Hispanic/Latinx children had double and white children had triple the odds of linkage compared with Black children (odds ratio [OR], 2.20; 95% CI, 1.05-4.59; OR, 3.44; 95% CI, 1.89-6.28) after adjusting for sex, birth cohort, and region. CONCLUSIONS Pediatric access to HCV care remains low. Fewer than 1 in 3 children linked to HCV care and fewer than 1 in 8 were treated. This study uncovers racial and ethnic disparities in HCV care access. Targeting interventions toward increasing linkage to care could represent an opportunity to advance HCV elimination goals and reduce disparities.