Regional disparities in hepatitis C treatment initiation and treatment delay in Saudi Arabia: a retrospective observational study
- 1Department of Epidemiology and Public Health, University College London, London, UK
- 2Global Business School for Health, University College London, London, UK
Abstract
Objectives To examine regional and sociodemographic inequities in access to timely hepatitis C treatment within Saudi Arabia’s national elimination programme.Design Retrospective observational study using a Heckman selection model to jointly estimate treatment initiation and subsequent delay.Setting National Hepatitis C Virus Elimination Programme in Saudi Arabia, using administrative data from 2018 to 2020.Participants A total of 1302 patients recorded in the national programme who were prescribed antiviral therapy and had complete information on treatment initiation and key covariates.Outcome measures The primary outcome was treatment initiation (binary). The secondary outcome was time to treatment initiation, measured as the number of days between prescription and treatment start among those who initiated therapy.Results Substantial regional disparities in treatment initiations and timeliness were identified. Compared with Riyadh, treatment delays were significantly longer in Najran (β=1.06, p<0.01) and AlBahah (β=1.03, p<0.01), while treatment initiation also varied substantially across regions. Non-Saudi patients were significantly less likely to initiate treatment (β=–0.38, p<0.05) and experienced longer delays among those who initiated treatment. Organisational capacity also influenced access, with higher hospital volume positively associated with treatment initiation (β=0.001, p<0.01). A significant correlation between the unobserved determinants of treatment initiation and delay (ρ=0.33, p<0.01) supported the need to account for non-random selection into treatment when estimating treatment delay.Conclusions Progress towards hepatitis C elimination in Saudi Arabia is characterised by important regional and population-level differences in treatment initiation and timeliness. These findings highlight the importance of evaluating elimination efforts not only in terms of overall treatment coverage but also by monitoring whether treatment is initiated promptly and equitably across regions and population groups.
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BibTeX
@article{alhussain2026regional,
title = {{Regional disparities in hepatitis C treatment initiation and treatment delay in Saudi Arabia: a retrospective observational study}},
author = {Abdulkarim Alhussain and Sonila M Tomini and Panayotes Demakakos},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-121143},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121143},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Regional disparities in hepatitis C treatment initiation and treatment delay in Saudi Arabia: a retrospective observational study
AU - Abdulkarim Alhussain
AU - Sonila M Tomini
AU - Panayotes Demakakos
PY - 2026
DA - 2026/10/30
JO - BMJ Open
DO - 10.1136/bmjopen-2026-121143
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121143
AB - Objectives To examine regional and sociodemographic inequities in access to timely hepatitis C treatment within Saudi Arabia’s national elimination programme.Design Retrospective observational study using a Heckman selection model to jointly estimate treatment initiation and subsequent delay.Setting National Hepatitis C Virus Elimination Programme in Saudi Arabia, using administrative data from 2018 to 2020.Participants A total of 1302 patients recorded in the national programme who were prescribed antiviral therapy and had complete information on treatment initiation and key covariates.Outcome measures The primary outcome was treatment initiation (binary). The secondary outcome was time to treatment initiation, measured as the number of days between prescription and treatment start among those who initiated therapy.Results Substantial regional disparities in treatment initiations and timeliness were identified. Compared with Riyadh, treatment delays were significantly longer in Najran (β=1.06, p<0.01) and AlBahah (β=1.03, p<0.01), while treatment initiation also varied substantially across regions. Non-Saudi patients were significantly less likely to initiate treatment (β=–0.38, p<0.05) and experienced longer delays among those who initiated treatment. Organisational capacity also influenced access, with higher hospital volume positively associated with treatment initiation (β=0.001, p<0.01). A significant correlation between the unobserved determinants of treatment initiation and delay (ρ=0.33, p<0.01) supported the need to account for non-random selection into treatment when estimating treatment delay.Conclusions Progress towards hepatitis C elimination in Saudi Arabia is characterised by important regional and population-level differences in treatment initiation and timeliness. These findings highlight the importance of evaluating elimination efforts not only in terms of overall treatment coverage but also by monitoring whether treatment is initiated promptly and equitably across regions and population groups.
SN - 2044-6055
SN - 2044-6055
ER -