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J Acquir Immune Defic Syndr. 2018 May 1;78(1):93-98. doi: 10.1097/QAI.0000000000001651.

HIV Serostatus and Having Access to a Physician for Regular Hepatitis C Virus Care Among People Who Inject Drugs.

Beaulieu T1, Hayashi K1,2,3, Milloy MJ1,2,4, Nosova E1,2, DeBeck K1,2,5, Montaner J1,4, Kerr T1,2,4, Ti L1,4.

Author information

1
Department of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
2
British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, British Columbia, Canada.
3
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
4
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
5
School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada.

Abstract

BACKGROUND:

People who inject drugs (PWIDs) and who are living with HIV and hepatitis C virus (HCV) infection are vulnerable to a range of health-related harms, including liver cirrhosis, hepatocellular carcinoma, and death. There is limited evidence describing how HIV serostatus shapes access to a physician for regular HCV care among PWID.

SETTING:

Data were collected through the Vancouver Injection Drug Users Study (VIDUS), the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), and the At-Risk Youth Study (ARYS), 3 prospective cohorts involving people who use illicit drugs in Vancouver, Canada, between 2005 and 2015.

METHODS:

Using generalized estimating equations, we examined the relationship between HIV-seropositivity and having access to a physician for regular HCV care. We conducted a mediation analysis to examine whether this association was mediated by increased frequency of engagement in health care.

RESULTS:

In total, 1627 HCV-positive PWID were eligible for analysis; 582 (35.8%) were HIV-positive at baseline; and 31 (1.9%) became HIV-positive during follow-up. In multivariable analyses, after adjusting for a range of confounders, HIV serostatus [adjusted odds ratio = 1.99; 95% confidence interval: 1.77 to 2.24] was significantly associated with having access to HCV care. Approximately 26% of the effect was due to mediation.

CONCLUSION:

Our results demonstrate a positive relationship between HIV-seropositivity and having access to a physician for regular HCV care, which is partially explained through increased frequency of engagement in health care. These findings highlight the need to address patterns of inequality in access to HCV care among PWID.

PMID:
29630030
PMCID:
PMC5894872
[Available on 2019-05-01]
DOI:
10.1097/QAI.0000000000001651

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