{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T09:26:54Z","timestamp":1782552414693,"version":"3.54.5"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T00:00:00Z","timestamp":1606608000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol. Commun."],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>There are limited data examining the relationship between psychosocial factors and receipt of direct\u2010acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health\u2010related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017\u20102018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow\u2010up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life\u2010related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow\u2010up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C\u2010related morbidity and mortality.<\/jats:p>","DOI":"10.1002\/hep4.1632","type":"journal-article","created":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T18:44:15Z","timestamp":1606675455000},"page":"400-411","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure"],"prefix":"10.1097","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7609-0485","authenticated-orcid":false,"given":"Philip R.","family":"Spradling","sequence":"first","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuna","family":"Zhong","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne C.","family":"Moorman","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loralee B.","family":"Rupp","sequence":"additional","affiliation":[{"name":"Henry Ford Health System,Detroit,MI,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3313-6428","authenticated-orcid":false,"given":"Mei","family":"Lu","sequence":"additional","affiliation":[{"name":"Henry Ford Health System,Detroit,MI,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart C.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Henry Ford Health System,Detroit,MI,USA"},{"name":"Wayne State University School of Medicine,Detroit,MI,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyasu H.","family":"Teshale","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Center for Health Research,Kaiser Permanente Northwest,Portland,OR,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihe G.","family":"Daida","sequence":"additional","affiliation":[{"name":"Center for Integrated Health Care Research,Kaiser Permanente Hawaii,Honolulu,HI,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Boscarino","sequence":"additional","affiliation":[{"name":"Department of 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