title: Increasing Hepatitis C treatment uptake among HIV-infected patients using an HIV primary care model.
abstract: BACKGROUND
  Access to Hepatitis C (HCV) care is low among HIV-infected individuals, highlighting the need for new models to deliver care for this population.
  
  
  METHODS
  Retrospective cohort analysis that compared the number of HIV patients who initiated HCV therapy: hepatology (2005-2008) vs. HIV primary care model (2008-2011). Logistic-regression modeling was used to ascertain factors associated with HCV therapy initiation and achievement of sustained viral response (SVR).
  
  
  RESULTS
  Of 196 and 163 patients that were enrolled in the HIV primary care and hepatology models, 48 and 26 were treated for HCV, respectively (p = 0.043). The HIV/HCV-patient referral rate did not differ during the two study periods (0.10 vs. 0.12/patient-yr, p = 0.18). In unadjusted analysis, predictors (p < 0.05) of HCV treatment initiation included referral to the HIV primary care model (OR: 1.7), a CD4+ count ≥400/mm3 (OR: 1.8) and alanine aminotranferase level ≥63U/L (OR: 1.9). Prior psychiatric medication use correlated negatively with HCV treatment initiation (OR: 0.6, p = 0.045). In adjusted analysis the strongest predictor of HCV treatment initiation was CD4+ count (≥400/mm3, OR: 2.1, p = 0.01). There was no significant difference in either clinic model (primary care vs. hepatology) in the rates of treatment discontinuation due to adverse events (29% vs. 16%), loss to follow-up (8 vs. 8%), or HCV SVR (44 vs. 35%).
  
  
  CONCLUSIONS
  Using a HIV primary care model increased the number of HIV patients who initiate HCV therapy with comparable outcomes to a hepatology model.
authors.affiliation: Department of Medicine, Owen Clinic, University of California at San Diego, 200 W, Arbor Drive, San Diego, CA, 92103-8681, USA. ecachay@ucsd.edu.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Cachay
authors.forename: Lucas
authors.initials: L
authors.lastname: Hill
authors.forename: Craig
authors.initials: C
authors.lastname: Ballard
authors.forename: Bradford
authors.initials: B
authors.lastname: Colwell
authors.forename: Francesca
authors.initials: F
authors.lastname: Torriani
authors.forename: David
authors.initials: D
authors.lastname: Wyles
authors.forename: William C
authors.initials: WC
authors.lastname: Mathews
references.citation: Liver Int. 2012 Sep;32(8):1194-9
references.pmid: 22510096
references.citation: AIDS. 2005 Oct;19 Suppl 3:S99-105
references.pmid: 16251836
references.citation: AIDS Res Ther. 2011 Aug 10;8:29
references.pmid: 21831314
references.citation: AIDS Care. 2012;24(4):434-43
references.pmid: 21999644
references.citation: J Gen Intern Med. 2004 Apr;19(4):357-65
references.pmid: 15061745
references.citation: Soc Sci Med. 2012 Jul;75(1):240-7
references.pmid: 22516762
references.citation: J Viral Hepat. 2011 May;18(5):316-24
references.pmid: 20367803
references.citation: Gen Hosp Psychiatry. 2005 Nov-Dec;27(6):431-8
references.pmid: 16271658
references.citation: Antivir Ther. 2012;17(3):571-5
references.pmid: 22293607
references.citation: J Addict Med. 2010 Dec;4(4):223-32
references.pmid: 21769040
references.citation: Subst Use Misuse. 2012 Jan;47(1):56-66
references.pmid: 22216992
references.citation: Nature. 2009 Sep 17;461(7262):399-401
references.pmid: 19684573
references.citation: Int J STD AIDS. 2011 Oct;22(10):571-6
references.pmid: 21998177
references.citation: Clin Infect Dis. 2012 May;54(10):1465-72
references.pmid: 22431808
references.citation: Hepatology. 2012 Nov;56(5):1651-60
references.pmid: 22610658
references.citation: N Engl J Med. 2009 Apr 30;360(18):1827-38
references.pmid: 19403902
references.citation: Lancet. 2011 Apr 2;377(9772):1198-209
references.pmid: 21459211
references.citation: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S349-54
references.pmid: 15768347
references.citation: AIDS Patient Care STDS. 2009 Nov;23(11):925-9
references.pmid: 19827950
references.citation: BMJ. 2012 Feb 20;344:e1266
references.pmid: 22349795
references.citation: N Engl J Med. 2011 Mar 31;364(13):1195-206
references.pmid: 21449783
references.citation: Hepatology. 2009 Apr;49(4):1335-74
references.pmid: 19330875
references.citation: Open Med. 2011;5(3):e120-31
references.pmid: 22046224
references.citation: Qual Health Res. 2012 Jan;22(1):54-66
references.pmid: 21825278
references.citation: Aust J Prim Health. 2011;17(3):282-7
references.pmid: 21896265
references.citation: Addiction. 2002 Sep;97(9):1183-94
references.pmid: 12199834
references.citation: AIDS Patient Care STDS. 2012 Sep;26(9):541-5
references.pmid: 22860997
references.citation: Antivir Ther. 2011;16(6):815-24
references.pmid: 21900713