title: Differences in outpatient care and treatment utilization for patients with HIV/HCV coinfection, HIV, and HCV monoinfection, a cross-sectional study.
abstract: BACKGROUND
  Few 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.
  
  
  METHODS
  Data 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.
  
  
  RESULTS
  3,021 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.
  
  
  CONCLUSIONS
  There 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.
authors.forename: Terence L
authors.initials: TL
authors.lastname: Johnson
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Toliver
authors.forename: Lu
authors.initials: L
authors.lastname: Mao
authors.affiliation: University of North Carolina, UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC 27599-7355, 2215 Kerr Hall, USA. oramsc@unc.edu.
authors.forename: Christine U
authors.initials: CU
authors.lastname: Oramasionwu
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D060085:Coinfection / Q000453:epidemiology* / Q000628:therapy* / Q000821:virology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy* / Q000821:virology; D006526:Hepatitis C / Q000453:epidemiology* / Q000628:therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged
references.citation: Int J Clin Pract. 2013 Jan;67(1):6-13
references.pmid: 23241046
references.citation: Dig Dis Sci. 2009 Dec;54(12):2694-8
references.pmid: 19104932
references.citation: Med J Aust. 2012 Jun 4;196(10):629-32
references.pmid: 22676877
references.citation: Clin Infect Dis. 2012 Jul;55 Suppl 1:S33-42
references.pmid: 22715212
references.citation: N Engl J Med. 1996 Oct 10;335(15):1091-8
references.pmid: 8813039
references.citation: Int J Infect Dis. 2009 Jul;13(4):449-55
references.pmid: 18993100
references.citation: Dig Dis Sci. 2010 Jun;55(6):1744-51
references.pmid: 20186486
references.citation: J Infect Dis. 2013 Mar;207 Suppl 1:S19-25
references.pmid: 23390301
references.citation: Clin Infect Dis. 2009 Nov 15;49(10):1605-15
references.pmid: 19842982
references.citation: AIDS Patient Care STDS. 2012 Sep;26(9):541-5
references.pmid: 22860997
references.citation: Gastroenterology. 2010 Nov;139(5):1593-601
references.pmid: 20637202
references.citation: Ann Emerg Med. 2012 Dec;60(6):716-721.e1
references.pmid: 23083968
references.citation: AIDS Patient Care STDS. 2009 Sep;23(9):715-25
references.pmid: 19663714
references.citation: MMWR Morb Mortal Wkly Rep. 2014 Feb 7;63(5):85-9
references.pmid: 24500286
references.citation: Hepatology. 2020 Feb;71(2):686-721
references.pmid: 31816111
references.citation: JAMA. 2012 Jul 25;308(4):370-8
references.pmid: 22820790
references.citation: J Viral Hepat. 2011 Jul;18(7):506-12
references.pmid: 20546501
references.citation: AIDS Behav. 2013 Jan;17(1):31-40
references.pmid: 23010941
references.citation: AIDS Patient Care STDS. 2009 Nov;23(11):925-9
references.pmid: 19827950
references.citation: N Engl J Med. 1998 Nov 19;339(21):1485-92
references.pmid: 9819446
references.citation: Hepatology. 2010 Sep;52(3):833-44
references.pmid: 20564351
references.citation: N Engl J Med. 2004 Jul 29;351(5):438-50
references.pmid: 15282351
references.citation: Hepatology. 2009 Aug;50(2):407-13
references.pmid: 19575364
references.citation: J Viral Hepat. 2010 Oct;17(10):720-9
references.pmid: 20002558
references.citation: South Med J. 2011 Dec;104(12):794-800
references.pmid: 22089356
references.citation: Liver Int. 2011 Sep;31(8):1090-101
references.pmid: 21745274
references.citation: J Viral Hepat. 2011 May;18(5):316-24
references.pmid: 20367803