{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T01:23:05Z","timestamp":1792891385453,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T00:00:00Z","timestamp":1647648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Despite the release of a growing number of direct\u2010acting antivirals and evolving policy landscape, many of those diagnosed with hepatitis C virus (HCV) have not received treatment. Those from vulnerable populations are at particular risk of being unable to access treatment, threatening World Health Organization (WHO) HCV elimination goals. The aim of this study was to understand the association between direct\u2010acting antivirals approvals, HCV\u2010related policy changes and access to HCV virus treatment in Indiana, and to explore access to treatment by race, birth cohort and insurance type. We performed a retrospective cohort study of adults with HCV from 05\/2011\u201003\/2021, using statewide electronic health data. Nine policy and treatment changes were defined a priori. A Lowess curve evaluated treatment trends over time. Monthly screening and treatment rates were examined. Multivariable logistic regression explored predictors of treatment. The population (N\u00a0=\u00a010,336) was 13.4% Black, 51.8% was born after 1965 and 44.7% was Medicaid recipients. Inflections in the Lowess curve defined four periods: (1) Interferon\u00a0+\u00a0DAA, (2) early direct\u2010acting antivirals, (3) Medicaid expansion\/optimization and (4) Medicaid restrictions (fibrosis\/prescriber) removed. The largest increase in monthly treatment rates was during period 4, when Medicaid prescriber and fibrosis restrictions were removed (2.4 persons per month [PPM] in period 1 to 72.3 PPM in period 4, <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.001; 78.0% change in slope). Multivariable logistic regression analysis showed being born after 1965 (vs. before 1945; OR 0.69; 95% 0.49\u20130.98) and having Medicaid (vs. private insurance; OR 0.47; 95% CI 0.42\u20130.53), but not race was associated with lower odds of being treated. In conclusion, DAAs had limited impact on HCV treatment rates until Medicaid restrictions were removed. Additional policies may be needed to address HCV treatment\u2010related age and insurance disparities.<\/jats:p>","DOI":"10.1111\/jvh.13661","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T13:14:17Z","timestamp":1646658857000},"page":"366-374","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Removal of medicaid restrictions were associated with increased hepatitis C virus treatment rates, but disparities persist"],"prefix":"10.1111","volume":"29","author":[{"given":"Lauren D.","family":"Nephew","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Indiana University Simon Comprehensive Cancer Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Indiana University Fairbanks School of Public Health and School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kawthar","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Nichols","sequence":"additional","affiliation":[{"name":"Indiana Department of Health Division of HIV\/STD and Viral Hepatitis  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Rawl","sequence":"additional","affiliation":[{"name":"Indiana University Simon Comprehensive Cancer Center  Indianapolis Indiana USA"},{"name":"Indiana University School of Nursing  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Orman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archita P.","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavish R.","family":"Patidar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Ghabril","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naga","family":"Chalasani","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica L.","family":"Kasting","sequence":"additional","affiliation":[{"name":"Indiana University Simon Comprehensive Cancer Center  Indianapolis Indiana USA"},{"name":"Department of Public Health Purdue University  West Lafayette Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1646"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3133-6"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.06.019"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-020-00392-3"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i38.10749"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29528"},{"issue":"2","key":"e_1_2_7_8_1","first-page":"61","article-title":"Impact of hepatitis C virus and insurance coverage on mortality","volume":"25","author":"Bush H","year":"2019","journal-title":"Am J Manag 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