{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T04:02:59Z","timestamp":1776484979663,"version":"3.51.2"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study evaluated the Cascade of Care (CoC) and real-world efficacy of direct-acting antivirals (DAAs) for hepatitis C treatment in pediatric and adolescent patients utilizing an integrated health system specialty pharmacy (HSSP) to assist with medication selection, insurance approval, swallowing practice, initiation, and monitoring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This single-center, retrospective, observational cohort study included chronic hepatitis C patients\u2005&amp;lt;18 years old evaluated by pediatric hepatologists at an academic health system between January 1, 2017 and September 30, 2022. The primary endpoint was sustained virologic response (SVR)\u2005\u226512 weeks following treatment completion in patients initiating DAAs. Secondary endpoints were CoC advancement, variables impacting DAA initiation, patient-reported side effects, and adherence. An ordinal logistic regression model assessed whether initiation time was associated with a patient\u2019s ability to swallow, prior authorization outcome, and medication availability to HSSP at referral. The odds ratio reflects the likelihood of a shift in time to initiation for a given group relative to its respective reference group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 98 patients evaluated by a hepatologist, 73 (75%) were referred to the HSSP. Loss to follow-up was the primary reason (88%; 22\/25) for nonreferral, most commonly (73%; 16\/22) in those aged\u2005\u22645 years. Following HSSP referral, 88% (64\/73) initiated DAA and 92% (59\/64) of those achieved SVR. Time from HSSP referral to medication initiation was impacted by DAA availability (OR\u2005=\u200541.47; 95% CI, 9.51-180.87; P\u2005&amp;lt;.001) and inability to swallow the dosage form at evaluation (OR\u2005=\u20053.94; 95% CI, 1.56-9.98; P\u2005=.004). Over half (53%; 34\/64) of patients initiating DAA reported\u2005\u22651 adverse event; none discontinued treatment. Most (69%; 44\/64) reported no missed doses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The largest CoC drop-off occurred following initial clinic evaluation, primarily in children aged\u2005\u22645 years. Enhanced linkage to care efforts is needed in these patients. Conversely, nearly all patients referred to the HSSP were initiated on DAA, completed therapy, and achieved SVR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piaf042","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T09:45:57Z","timestamp":1746524757000},"source":"Crossref","is-referenced-by-count":2,"title":["Pediatric and Adolescent Hepatitis C Care Cascade and Real-World Treatment Outcomes Utilizing an Integrated Health System Specialty Pharmacy Model"],"prefix":"10.1093","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7810-3582","authenticated-orcid":false,"given":"Alicia B","family":"Carver","sequence":"first","affiliation":[{"name":"Specialty Pharmacy Services, Vanderbilt University Medical Center , Nashville, TN ,","place":["United 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