title: HIV Infection Status as a Predictor of Hepatitis C Virus RNA Testing in Primary Care.
abstract: BACKGROUND
  Receipt of hepatitis C virus (HCV) RNA testing following a positive HCV antibody (anti-HCV+) test result to establish current infection is a quality indicator for HCV-related care. This study examines HIV infection status as a predictor of HCV RNA test receipt after an anti-HCV+ result in the primary care setting.
  
  
  METHODS
  Electronic medical records of anti-HCV+ patients from a multisite retrospective study of patients aged ≥18 years who utilized one or more primary care outpatient services during 2005-2010 were analyzed in 2014. A multivariable logistic regression model examined the independent relationships between patient characteristics and receipt of HCV RNA testing.
  
  
  RESULTS
  Among 1,115 anti-HCV+ patients, 133 (11.9%) were also HIV-positive. Of these, 77.4% (n=103) underwent HCV RNA testing to determine current infection status. By contrast, 66.7% (n=654/980) of anti-HCV+ patients who were HIV-negative received HCV RNA testing. Following multivariable adjustment, the odds of receiving HCV RNA testing were higher among anti-HCV+ patients who were also HIV-positive (AOR=1.9, 95% CI=1.2, 3.0), compared with their HIV-negative counterparts. Elevated alanine aminotransferase level was also associated with receipt of HCV RNA testing (AOR=1.9, 95% CI=1.4, 2.4). Black race was associated with decreased odds of receiving HCV RNA testing (AOR=0.7, 95% CI=0.5, 1.0).
  
  
  CONCLUSIONS
  HIV infection status is independently associated with the likelihood of receiving HCV RNA testing following an anti-HCV+ result. One quarter of anti-HCV+ patients who were also HIV-positive and one third of their HIV-negative counterparts, respectively, did not receive testing to establish active HCV infection, which is imperative for appropriate care and treatment.
authors.affiliation: CDC Foundation, Atlanta, Georgia. Electronic address: jqi0@cdc.gov.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Yartel
authors.affiliation: Division of Viral Hepatitis, CDC, Atlanta, Georgia.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Morgan
authors.affiliation: Public Health Department, NORC at the University of Chicago, Atlanta, Georgia.
authors.forename: David B
authors.initials: DB
authors.lastname: Rein
authors.affiliation: Department of Medicine, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ann Brown
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Natalie B
authors.initials: NB
authors.lastname: Kil
authors.affiliation: Department of Medicine, University of Alabama at Birmingham (Massoud), Birmingham, Alabama.
authors.forename: Omar I
authors.initials: OI
authors.lastname: Massoud
authors.affiliation: Department of Internal Medicine, the University of Texas Medical School at Houston (Fallon), Houston, Texas.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fallon
authors.affiliation: Division of Viral Hepatitis, CDC, Atlanta, Georgia.
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
mesh_terms: D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D018937:Hepatitis C Antibodies / Q000276:immunology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012367:RNA, Viral / Q000097:blood*; D012189:Retrospective Studies
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral