Cargando…
Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study
OBJECTIVES: Little is known about the cascade of hepatitis C care among HIV/hepatitis C virus (HCV)-coinfected patients in community-based clinics. Thus, we analysed our data from the interferon era to understand the barriers to HCV treatment, which may help improve getting patients into treatment i...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475218/ https://www.ncbi.nlm.nih.gov/pubmed/30928964 http://dx.doi.org/10.1136/bmjopen-2018-027411 |
_version_ | 1783412737035993088 |
---|---|
author | Chen, Yun-Chi Thio, Chloe L Cox, Andrea L Ruhs, Sebastian Kamangar, Farin Wiberg, Kjell J |
author_facet | Chen, Yun-Chi Thio, Chloe L Cox, Andrea L Ruhs, Sebastian Kamangar, Farin Wiberg, Kjell J |
author_sort | Chen, Yun-Chi |
collection | PubMed |
description | OBJECTIVES: Little is known about the cascade of hepatitis C care among HIV/hepatitis C virus (HCV)-coinfected patients in community-based clinics. Thus, we analysed our data from the interferon era to understand the barriers to HCV treatment, which may help improve getting patients into treatment in the direct-acting antivirals era. DESIGN: Retrospective cohort study. SETTING: Four HIV clinics of a multisite community health centre in the USA. PARTICIPANTS: 1935 HIV-infected men with >1 medical visit to the clinic between 2011 and 2013. Of them, 371 had chronic HCV and were included in the analysis for HCV care continuum during 2003–2014. OUTCOME MEASURES: HCV treatment initiation was designated as the primary outcome for analysis. Multivariate logistic regression was performed to identify factors associated with HCV treatment initiation. RESULTS: Among the 371 coinfected men, 57 (15%) initiated HCV treatment. Entering care before 2008 (adjusted OR [aOR, 3.89; 95% CI, 1.95 to 7.78), higher educational attainment (aOR, 3.20; 95% CI, 1.59 to 6.44), HCV genotype 1 versus non-1 (aOR, 0.21; 95% CI, 0.07 to 0.65) and HIV suppression (aOR, 2.13; 95% CI, 1.12 to 4.06) independently predicted treatment initiation. Stratification by entering care before or after 2008 demonstrated that higher educational attainment was the only factor independently associated with treatment uptake in both periods (aOR, 2.79; 95% CI, 1.13 to 6.88 and aOR, 4.10; 95% CI, 1.34 to 12.50, pre- and post-2008, respectively). Additional associated factors in those entering before 2008 included HCV genotype 1 versus non-1 (aOR, 0.09; 95% CI, 0.01 to 0.54) and HIV suppression (aOR, 2.35; 95% CI, 1.04 to 5.33). CONCLUSIONS: Some traditional barriers predicted HCV treatment initiation in those in care before 2008; however, the patients’ level of educational attainment remained an important factor even towards the end of the interferon era. Further studies will need to determine whether educational attainment persists as an important determinant for initiating direct-acting antiviral therapies. |
format | Online Article Text |
id | pubmed-6475218 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-64752182019-05-07 Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study Chen, Yun-Chi Thio, Chloe L Cox, Andrea L Ruhs, Sebastian Kamangar, Farin Wiberg, Kjell J BMJ Open HIV/AIDS OBJECTIVES: Little is known about the cascade of hepatitis C care among HIV/hepatitis C virus (HCV)-coinfected patients in community-based clinics. Thus, we analysed our data from the interferon era to understand the barriers to HCV treatment, which may help improve getting patients into treatment in the direct-acting antivirals era. DESIGN: Retrospective cohort study. SETTING: Four HIV clinics of a multisite community health centre in the USA. PARTICIPANTS: 1935 HIV-infected men with >1 medical visit to the clinic between 2011 and 2013. Of them, 371 had chronic HCV and were included in the analysis for HCV care continuum during 2003–2014. OUTCOME MEASURES: HCV treatment initiation was designated as the primary outcome for analysis. Multivariate logistic regression was performed to identify factors associated with HCV treatment initiation. RESULTS: Among the 371 coinfected men, 57 (15%) initiated HCV treatment. Entering care before 2008 (adjusted OR [aOR, 3.89; 95% CI, 1.95 to 7.78), higher educational attainment (aOR, 3.20; 95% CI, 1.59 to 6.44), HCV genotype 1 versus non-1 (aOR, 0.21; 95% CI, 0.07 to 0.65) and HIV suppression (aOR, 2.13; 95% CI, 1.12 to 4.06) independently predicted treatment initiation. Stratification by entering care before or after 2008 demonstrated that higher educational attainment was the only factor independently associated with treatment uptake in both periods (aOR, 2.79; 95% CI, 1.13 to 6.88 and aOR, 4.10; 95% CI, 1.34 to 12.50, pre- and post-2008, respectively). Additional associated factors in those entering before 2008 included HCV genotype 1 versus non-1 (aOR, 0.09; 95% CI, 0.01 to 0.54) and HIV suppression (aOR, 2.35; 95% CI, 1.04 to 5.33). CONCLUSIONS: Some traditional barriers predicted HCV treatment initiation in those in care before 2008; however, the patients’ level of educational attainment remained an important factor even towards the end of the interferon era. Further studies will need to determine whether educational attainment persists as an important determinant for initiating direct-acting antiviral therapies. BMJ Publishing Group 2019-03-30 /pmc/articles/PMC6475218/ /pubmed/30928964 http://dx.doi.org/10.1136/bmjopen-2018-027411 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | HIV/AIDS Chen, Yun-Chi Thio, Chloe L Cox, Andrea L Ruhs, Sebastian Kamangar, Farin Wiberg, Kjell J Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study |
title | Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study |
title_full | Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study |
title_fullStr | Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study |
title_full_unstemmed | Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study |
title_short | Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study |
title_sort | trends in hepatitis c treatment initiation among hiv/hepatitis c virus-coinfected men engaged in primary care in a multisite community health centre in maryland: a retrospective cohort study |
topic | HIV/AIDS |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475218/ https://www.ncbi.nlm.nih.gov/pubmed/30928964 http://dx.doi.org/10.1136/bmjopen-2018-027411 |
work_keys_str_mv | AT chenyunchi trendsinhepatitisctreatmentinitiationamonghivhepatitiscviruscoinfectedmenengagedinprimarycareinamultisitecommunityhealthcentreinmarylandaretrospectivecohortstudy AT thiochloel trendsinhepatitisctreatmentinitiationamonghivhepatitiscviruscoinfectedmenengagedinprimarycareinamultisitecommunityhealthcentreinmarylandaretrospectivecohortstudy AT coxandreal trendsinhepatitisctreatmentinitiationamonghivhepatitiscviruscoinfectedmenengagedinprimarycareinamultisitecommunityhealthcentreinmarylandaretrospectivecohortstudy AT ruhssebastian trendsinhepatitisctreatmentinitiationamonghivhepatitiscviruscoinfectedmenengagedinprimarycareinamultisitecommunityhealthcentreinmarylandaretrospectivecohortstudy AT kamangarfarin trendsinhepatitisctreatmentinitiationamonghivhepatitiscviruscoinfectedmenengagedinprimarycareinamultisitecommunityhealthcentreinmarylandaretrospectivecohortstudy AT wibergkjellj trendsinhepatitisctreatmentinitiationamonghivhepatitiscviruscoinfectedmenengagedinprimarycareinamultisitecommunityhealthcentreinmarylandaretrospectivecohortstudy |