Differences in outpatient care and treatment utilization for patients with HIV/HCV coinfection, HIV, and HCV monoinfection, a cross-sectional study

Abstract

BackgroundFew studies have explored how utilization of outpatient services differ for HIV/HCV coinfected patients compared to HIV or HCV monoinfected patients. The objectives of this study were to (1) compare annual outpatient clinic visit rates between coinfected and monoinfected patients, (2) to compare utilization of HIV and HCV therapies between coinfected and monoinfected patients, and (3) to identify factors associated with therapy utilization.MethodsData were from the 2005–2010 U.S. National Hospital Ambulatory Medical Care Surveys. Clinic visits with a primary or secondary ICD-9-CM codes for HIV or HCV were included. Coinfection included visits with codes for both HIV and HCV. Monoinfection only included codes for HIV or HCV, exclusively. Patients <15 years of age at time of visit were excluded. Predictors of HIV and HCV therapy were determined by logistic regressions. Visits were computed using survey weights.Results3,021 visits (11,352,000 weighted visits) met study criteria for patients with HIV/HCV (8%), HIV (70%), or HCV (22%). The HCV subgroup was older in age and had the highest proportion of females and whites as compared to the HIV/HCV and HIV subgroups. Comorbidities varied significantly across the three subgroups (HIV/HCV, HIV, HCV): current tobacco use (40%, 27%, 30%), depression (32%, 23%, 24%), diabetes (9%, 10%, 17%), and chronic renal failure (<1%, 3%, 5%), (p < 0.001 for all variables). Annual visit rates were highest in those with HIV, followed by HIV/HCV, but consistently lower in those with HCV. HIV therapy utilization increased for both HIV/HCV and HIV subgroups. HCV therapy utilization remained low for both HIV/HCV and HCV subgroups for all years. Coinfection was an independent predictor of HIV therapy, but not of HCV therapy.ConclusionThere is a critical need for system-level interventions that reduce barriers to outpatient care and improve uptake of HCV therapy for patients with HIV/HCV coinfection.

Hepatitis C Testing, Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study

“…Used in combination with enhanced efforts to engage patients in care and shared health care models between regional specialized HCV clinics and primary care providers, there is great opportunity to increase treatment initiation and completion in this population. Overall, our results suggest that innovative approaches to HCV care for PWID should be considered, including involving peers in care, locating care in harm reduction environments, integration of HCV care with substance use and social service delivery, and use of telehealth services (Gonzalez et al, 2017;Johnson et al, 2014;Meyer et al, 2015;Talal, Thomas, Reynolds, & Khalsa, 2017;Tyndall, 2015).…”

“…Our results are also consistent with other studies that have found low rates of treatment (Public Health Agency of Canada, 2013). People who use drugs face multiple barriers to care, including at the provider level (e.g., discrimination), system level (e.g., lack of drug insurance, lack of flexible clinic hours), and structural level (e.g., laws related to drug use); these barriers also interact in dynamic ways within specific contexts (Grebely et al, 2013b;Johnson, Toliver, Mao, & Oramasionwu, 2014;Wagner et al, 2009;Wolfe et al, 2015). Patient-related barriers, such as frequent injecting of drugs, may also be important, although evidence indicates that people who are actively using drugs can also be highly treatment adherent (Gonzalez, Fierer, & Talal, 2017;Grebely et al, 2013a).…”

Changes in the Profile and Care of HIV-HCV Seropositive Patients in Two Cross-Sectional Surveys in France (2006 and 2013)

“…Caring for patients who use illicit drugs presents challenges to the health care team that require patience, experience, and an understanding of the dynamics of substance use and addiction. Nonetheless, programs are successfully integrating hepatitis C care for IV drug users into health-care settings [29]. Patient-level barriers include non-adherence to medical care, refusal of therapy, and social circumstances [31,32].…”

On-site bundled rapid HIV/HCV testing in substance use disorder treatment programs: study protocol for a hybrid design randomized controlled trial

“…Additional measures will evaluate linkage to care by measuring the proportion of patients who initiated HIV care or HCV care before the 3-month follow-up among those whose test results were positive for HIV and/or HCV. Linkage to care for HIV or HCV will be measured separately, to account for variations in barriers to initiating care, which may be greater for HCV than barriers to initiating HIV medical care [ 67 ].…”