title: Variation between Canadian centres in the uptake of treatment for hepatitis C by patients coinfected with HIV: a prospective cohort study.
abstract: BACKGROUND
  Uptake of treatment for hepatitis C virus (HCV) is low in Canada despite its publicly funded health care system. We explored the uptake of HCV treatment within the Canadian Co-infection Cohort to determine if some treatment centres have been more successful than others at starting patients with HIV-HCV coinfection on HCV treatment.
  
  
  METHODS
  We estimated the variation between 16 centres in the uptake of HCV treatment using a Weibull time-to-event model with adjustment for patient characteristics that are thought likely to influence the uptake of treatment. We asked the principal investigator at each centre about access to hepatitis-related specialists and services and the importance of various criteria when determining if a patient with HIV-HCV coinfection should receive treatment for HCV.
  
  
  RESULTS
  Among 681 untreated patients in the Canadian Co-infection Cohort, 163 patients with HIV-HCV coinfection started HCV treatment over a period of 1827 patient-years (9 per 100 patient-years). Even after adjustment for case mix, there was still appreciable variation in treatment uptake between centres, with mean hazard ratios of 0.43 (95% credible interval 0.11-1.3) and 3.6 (95% credible interval 1.7-8.4) for the centres least and most likely to start an average patient with HIV-HCV coinfection on HCV treatment. The most important criteria reported by principal investigators for determining eligibility for treatment were severity of fibrosis, current psychiatric comorbidities, current alcohol intake, past HCV treatment and a history of reinfection with HCV. However, the opinions were wide-ranging: 8 of the 15 criteria elicited both the responses "less important" and "very important."
  
  
  CONCLUSIONS
  The magnitude of the centre effects and diverse opinions about the importance of treatment eligibility criteria suggest that provider-related barriers to HCV treatment uptake are as important as patient-related barriers.
authors: Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, Que. ; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
authors: Jim
authors: J
authors: Young
authors: Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, Que.
authors: Martin
authors: M
authors: Potter
authors: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Que. ; Immune Deficiency Treatment Centre, Montreal General Hospital, McGill University Health Centre, Montréal, Que.
authors: Joseph
authors: J
authors: Cox
authors: The Ottawa Hospital - General Campus, Ottawa, Ont.
authors: Curtis
authors: C
authors: Cooper
authors: Southern Alberta HIV Clinic, Calgary, Alta.
authors: John
authors: J
authors: Gill
authors: BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, BC.
authors: Mark
authors: M
authors: Hull
authors: University Health Network, University of Toronto, Toronto, Ont.
authors: Sharon
authors: S
authors: Walmsley
authors: Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, Que.
authors: Marina B
authors: MB
authors: Klein