THE RED SECTIONLack of Health Insurance Limits the Benefits of Hepatitis C Virus Screening: Insights from the National Health and Nutrition Examination Hepatitis C Follow-Up StudyDitah, Ivo MD, MPhil1; Al Bawardy, Badr MD1; Gonzalez, Humberto C MD2; Saberi, Behnam MD1; Ditah, Callistus3; Kamath, Patrick S MD1,5; Charlton, Michael MD4,5Author Information 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA 2Department of Transplant Surgery, Methodist University Hospital, University of Tennessee, Memphis, Tennessee, USA 3University of Michigan Medical School, Ann Arbor, Michigan, USA 4Hepatology and Liver Transplantation, Intermountain Medical Center, Salt Lake City, Utah, USA Correspondence: Ivo Ditah MD, MPhil, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. E-mail: Ditah.firstname.lastname@example.org and email@example.com 5Drs P.S. Kamath and M. Charlton are equal co-last authors SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/B115 Received 02 October 2014; accepted 02 January 2015 Guarantor of the article: Ivo C. Ditah, MD, MPhil. Specific author contributions: Involved in study conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, study supervision: Ivo Ditah, Callistus Ditah, Michael Charlton, and Patrick S. Kamath; involved in acquisition of data; revision of manuscript: Humberto C. Gonzalez and Behnam Saberi. Financial support: None. Potential competing interests: None. American Journal of Gastroenterology: August 2015 - Volume 110 - Issue 8 - p 1126-1133 doi: 10.1038/ajg.2015.31 Buy SDC Metrics Abstract Objectives: Identifying barriers to access to hepatitis C virus (HCV) treatment among screen detected subjects is critical for any public health strategy aimed at controlling HCV infection in the general population. Methods: Data from the National Health and Nutrition Examination Survey HCV Follow-up study from 2001 to 2010 were used. Participants who tested positive for HCV were sent a letter informing them of their test results and advised to pursue further evaluation. Information on HCV transmission and its potential complications was also provided to all positive participants. These subjects were recontacted 6 months after notification to determine what action they had taken regarding the positive result. Results: Of 38,025 participants, 502 tested positive for HCV infection, giving a prevalence of 1.3% (95% confidence interval (CI) 0.8%, 1.8%). A total of 205 subjects participated in the 6-month follow-up interview. Those who could not be reached were more likely to be less educated, injecting drugs, and not to have health insurance. Half (50.2%) of the positive individuals were not aware of their status before notification. A total of 166 (81%) had pursued further evaluation. Only 18 (26.9%) received therapy. The main reason for not receiving treatment was high cost (19.4%). In adjusted analysis, the only barrier to pursuing downstream HCV care was the lack of health insurance (2.76, 95% CI 1.54, 7.69;P=0.007). Conclusions: This study suggests that the lack of health insurance may attenuate the theoretical benefits of a screening program that identifies asymptomatic HCV-infected individuals who are less likely to pursue downstream care. © The American College of Gastroenterology 2015. All Rights Reserved.