title: The hepatitis C cascade of care among HIV infected patients: a call to address ongoing barriers to care.
abstract: BACKGROUND
  The aims were to investigate the hepatitis C (HCV) cascade of care among HIV-infected patients and to identify reasons for not referring for and not initiating HCV therapy after completion of HCV treatment staging.
  
  
  METHODS
  Retrospective cohort analysis of HIV-infected patients under care at the University of California, San Diego (UCSD). We identified patients screened for and diagnosed with active HCV infection. Logistic regression analyses were used to identify factors associated with lack of referral for HCV therapy. Electronic medical records were reviewed to ascertain reasons for not initiating HCV therapy.
  
  
  RESULTS
  Between 2008 and 2012, 4725 HIV-infected patients received care at the UCSD Owen clinic. Most patients [4534 (96%)] were screened for HCV, 748 (16%) patients had reactive serum HCV antibodies but only 542 patients had active HCV infection. Lack of engagement in care was the most important predictor of non-referral for HCV therapy [odds ratio (OR): 5.08, 95% confidence interval 3.24-6.97, p<0.00001]. Other significant predictors included unstable housing (OR: 2.26), AIDS (OR: 1.83), having a detectable HIV viral load (OR: 1.98) and being non-white (OR: 1.67). The most common reason (40%) for not initiating or deferring HCV therapy was the presence of ongoing barriers to care.
  
  
  CONCLUSIONS
  Screening for HCV in HIV-infected patients linked to care is high but almost half of patients diagnosed with HCV are not referred for HCV therapy. Despite improvements in HCV therapy the benefits will not be realized unless effective measures for dealing with barriers to care are implemented.
authors.affiliation: Department of Medicine, Owen Clinic, University of California San Diego, San Diego, California, United States of America; Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, California, United States of America.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Cachay
authors.affiliation: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California, United States of America.
authors.forename: Lucas
authors.initials: L
authors.lastname: Hill
authors.affiliation: Department of Medicine, Owen Clinic, University of California San Diego, San Diego, California, United States of America; Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, California, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Wyles
authors.affiliation: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California, United States of America.
authors.forename: Bradford
authors.initials: B
authors.lastname: Colwell
authors.affiliation: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California, United States of America.
authors.forename: Craig
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Department of Medicine, Owen Clinic, University of California San Diego, San Diego, California, United States of America; Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, California, United States of America.
authors.forename: Francesca
authors.initials: F
authors.lastname: Torriani
authors.affiliation: Department of Medicine, Owen Clinic, University of California San Diego, San Diego, California, United States of America.
authors.forename: William C
authors.initials: WC
authors.lastname: Mathews
mesh_terms: D000328:Adult; D000368:Aged; D060085:Coinfection / Q000188:drug therapy / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000821:virology*; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load / Q000502:physiology; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies