Furthermore, we found that only 24% of HCV+ individuals without insurance had any knowledge of their chronic liver disease (compared with 50% among insured; P = 0.0300). Better insurance coverage

may not only improve antiviral treatment rates, but also enhance rates of hepatitis C testing (i.e., screening) Bioactive Compound Library concentration and diagnosis, particularly among those who are at high risk for infection. Furthermore, early diagnosis and counseling may enhance patients’ knowledge about their liver disease and may increase antiviral treatment rates by identifying patients earlier in the course of their disease. We also found that HCV+ individuals without health insurance were more likely to report history of alcohol abuse and were less likely to be educated than IWR1 insured. It is plausible that the high prevalence of social comorbidity and lack of education may still hamper

treatment acceptance and initiation among individuals after they are diagnosed with HCV infection. To make any impact on the burden of HCV and to cover the gap between efficacy and effectiveness, not only more individuals need to be screened for and diagnosed with HCV, but more focus is needed on HCV-related social services and education—comprehensive HCV care that may be best delivered through medical homes using the chronic care model approach.3 Our data show that currently, 1.2% of the United States population has active HCV viremia. This rate is lower than the previously reported national prevalence rate of CHC calculated using NHANES III, which was conducted

between 1988 and 1994.19, 20 This drop is most likely related to the recent decline in the incidence of new cases of HCV infection coupled with treatment availability. The strength of our study PIK3C2G is the use of contemporary United States population-based data. Although similar data on treatment eligibility are available from the Veterans Administration,20, 21, 22 these are the first large-scale data that may be generalizable to all HCV-infected individuals in the community setting. Furthermore, the NHANES study design provides standardized data collection and follow-up, thus there are no ascertainment or selection biases. The main limitation of the study is that, though it is based on population-level data, the sample of HCV-infected individuals used for calculations is still relatively small. Another important limitation is that, after applying our study eligibility criteria, a large portion of NHANES participants was excluded primarily due to the age requirement (age >18 years at the time of examination). Furthermore, a proportion of adults was excluded because of incomplete insurance questionnaires and absence of hepatitis C serologic tests.