Differences in access to care among injection drug users infected either with HIV and hepatitis C or hepatitis C alone

Abstract

Access to HCV (Hepatitis C virus) care for HIV/HCV-co-infected patients is an urgent public health concern. The objective of the present study was to describe the self-reported health status of HIV/HCV-co-infected and HCV-mono-infected injection drug users and to describe their access to HCV-related care. Beginning in May 1996, persons who had injected illicit drugs in the previous month were recruited into the Vancouver Injection Drug User Study (VIDUS). At baseline and then semi-annually, participants complete an interviewer-administered questionnaire. Blood is drawn at each semi-annual interview and tested for HIV and Hepatitis C infection. Data for this descriptive, cross-sectional study were drawn from the most recent of either the July 2003 or December 2003 nurse-administered questionnaire. Statistics used were the chi-square, Wilcoxon Rank Sum and Student's t-test. Logistic regression was used to examine factors independently associated with accessing HCV care. There were 707 individuals eligible for this analysis, including 240 HIV/HCV-co-infected and 467 HCV-mono-infected persons. Co-infected individuals were more likely to be female, younger, of Aboriginal ethnicity and less likely to use heroin daily. The HCV-mono-infected group tended to report higher rates of HCV-related symptoms, including fatigue, liver pain, nausea, night-sweats and stomach pain. However, it was the HIV/HCV-co-infected group who were more likely to report that they believed their hepatitis C was affecting them. The HIV/HCV-co-infected group were also more likely to report having received any hepatitis-related follow-up care, including blood work, liver biopsies and referrals to specialists. In logistic regression analysis, factors independently associated with ever receiving any hepatitis C related follow-up were HIV/HCV-co-infection (AOR 3.1; 95% CI: 2–4.7), being older (AOR 1.04; 95% CI: 1.02–1.06 per year older), using heroin daily (AOR 0.54; 95% CI: 0.36–0.82) and believing that hepatitis C was affecting one's health (AOR 1.4; 95% CI: 1.0–2.1). In conclusion, our data indicate more HCV healthcare utilization among those HIV/HCV-co-infected.

Acknowledgments

The authors are indebted to the participants, physicians, nurses and clinic staff of the Vancouver Injection Drug Users Cohort, in addition to the Community Advisory Committee of the cohort. We also thank Bonnie Devlin, John Charette, Caitlin Johnston, Robin Brooks, Martin Schechter, Steve Kain, Kathy Churchill, Dave Isham, Will Small, Peter Vann, Sue Currie and Nancy Laliberte for their research and administrative assistance.

This work was supported by the Canadian Institutes of Health Research (CIHR) through a Doctoral Fellowship to Dr. Paula Braitstein, an Investigator Award to Dr. Robert Hogg and an Operating Grant (122258). This work was also supported by the Micheal Smith Foundation for Health Research through a Doctoral Fellowship to Dr. Braitstein and a Senior Scholar Award to Dr. Hogg. The study was further supported by the US National Institutes of Health.