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Important factors in this population include alcoholism and substance abuse, mental illness and homelessness, which may be combined with mistrust, poor health literacy, limited access to healthcare and outright discrimination. Systemic barriers to effective care include a lack of capacity to provide comprehensive care, insufficient insurance coverage, poor coordination among caregivers and between caregivers and hospitals, as well as third party payers. These barriers affect real world treatment effectiveness as opposed to treatment efficacy, the latter reflecting the world of clinical trials. The components of effectiveness include efficacious medications, appropriate diagnosis and evaluation, recommendation for therapy, access to therapy, acceptance of the diagnosis and its implications by the patient and adherence to the recommended therapy. Very little attention has been given to assisting the patient to accept the diagnosis and adhere to therapy, i.e. care coordination. For this reason, care coordination is an area in which greater availability could lead to greater acceptance\/adherence and greater treatment effectiveness.<\/jats:p>","DOI":"10.1111\/liv.12467","type":"journal-article","created":{"date-parts":[[2014,1,13]],"date-time":"2014-01-13T06:23:44Z","timestamp":1389594224000},"page":"668-671","source":"Crossref","is-referenced-by-count":11,"title":["Treatment of chronic hepatitis C virus infection in the United States: some remaining obstacles"],"prefix":"10.1111","volume":"34","author":[{"given":"Gloria","family":"Searson","sequence":"first","affiliation":[{"name":"Coalition on Positive Health Empowerment New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen S.","family":"Engelson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine St. Luke's and Roosevelt Hospitals Icahn School of Medicine at Mount Sinai New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damaris","family":"Carriero","sequence":"additional","affiliation":[{"name":"Coalition on Positive Health Empowerment New York NY USA"},{"name":"Center for Liver Disease and Transplantation Columbia University Medical Center New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald P.","family":"Kotler","sequence":"additional","affiliation":[{"name":"Coalition on Positive Health Empowerment New York NY USA"},{"name":"Division of Gastroenterology Department of Medicine St. Luke's and Roosevelt Hospitals Icahn School of Medicine at Mount Sinai New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,2,7]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012912"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1010494"},{"key":"e_1_2_3_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25528"},{"key":"e_1_2_3_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.09.067"},{"key":"e_1_2_3_6_1","volume-title":"Consequences of Hepatitis C Virus: Costs of a Baby Boomer Epidemic of Liver Disease","author":"Pyenson B","year":"2009"},{"key":"e_1_2_3_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-10-200605160-00004"},{"key":"e_1_2_3_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/474S18a"},{"key":"e_1_2_3_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-157-9-201211060-00529"},{"key":"e_1_2_3_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25556"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature08309"},{"key":"e_1_2_3_12_1","unstructured":"New York City Department of Health and Mental Hygiene Division of Disease Control Bureau of Communicable Diseases. 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