title: Visits to primary care physicians among persons who inject drugs at high risk of hepatitis C virus infection: room for improvement.
abstract: The role of primary care physicians (PCP) in hepatitis C virus (HCV) prevention is increasingly emphasized. Yet, little is known about the patterns of contacts with PCP among persons who inject drugs (PWID). We sought to assess the 6-month prevalence of PCP visiting among PWID at risk of HCV infection and to explore the associated factors. Baseline data were collected from HCV-seronegative PWID recruited in HEPCO, an observational Hepatitis Cohort study (2004-2011) in Montreal, Canada. An interviewer-administered questionnaire elicited information on socio-demographic factors, drug use patterns and healthcare services utilization. Blood samples were tested for HCV antibodies. Using the Gelberg-Andersen Behavioral Model, hierarchical logistic regression analyses were conducted to identify predisposing, need and enabling factors associated with PCP visiting. Of the 349 participants (mean age = 34; 80.8% male), 32.1% reported visiting a PCP. In the multivariate model, among predisposing factors, male gender [adjusted odds ratio (AOR) = 0.45 (0.25-0.83)], chronic homelessness [AOR = 0.08 (0.01-0.67)], cocaine injection [AOR = 0.46 (0.28-0.76)] and reporting greater illegal or semi-legal income [AOR = 0.48 (0.27-0.85)] were negatively associated with PCP visits. Markers of need were not associated with the outcome. Among enabling factors, contact with street nurses [AOR = 3.86 (1.49-9.90)] and food banks [AOR = 2.01 (1.20-3.37)] was positively associated with PCP visiting. Only one third of participating PWID reported a recent visit to a PCP. While a host of predisposing factors seems to hamper timely contacts with PCP among high-risk PWID, community-based support services may play an important role in initiating dialogue with primary healthcare services in this population.
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.|Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada.
authors.forename: A A
authors.initials: AA
authors.lastname: Artenie
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.|Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Jutras-Aswad
authors.affiliation: Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.|Montréal Public Health Department, Agence de la santé et des services sociaux de Montréal, Montréal, QC, Canada.
authors.forename: É
authors.initials: É
authors.lastname: Roy
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Zang
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.
authors.forename: J-M
authors.initials: JM
authors.lastname: Bamvita
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.|Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Lévesque
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.|Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada.|Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Bruneau
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009819:Office Visits; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D018937:Hepatitis C Antibodies
keywords: drug use; hepatitis C; injection; physician; primary care