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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...

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Autores principales: Chen, Yun-Chi, Thio, Chloe L, Cox, Andrea L, Ruhs, Sebastian, Kamangar, Farin, Wiberg, Kjell J
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
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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.
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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
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