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Open Access Research article

Engaging HIV-HCV co-infected patients in HCV treatment: the roles played by the prescribing physician and patients' beliefs (ANRS CO13 HEPAVIH cohort, France)

Dominique Salmon-Ceron1, Julien Cohen234, Maria Winnock56, Perrine Roux27, Firouze Bani Sadr8, Eric Rosenthal9, Isabelle Poizot Martin1023, Marc-Arthur Loko56, Marion Mora234, Philippe Sogni1112, Bruno Spire234, François Dabis56, Maria Patrizia Carrieri234* and the HEPAVIH group

Author Affiliations

1 Unité de Maladies Infectieuses, Pôle Médecine, Hôpital COCHIN, Paris, France

2 INSERM, U912 (SESSTIM), Marseille, France

3 Université Aix Marseille, IRD, UMR-S912, Marseille, France

4 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France

5 Univ Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France

6 INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France

7 Substance Use Research Center, NYSPI, Columbia University, New York, NY, USA

8 Hôpital Tenon-, INSERM U 707, Université Pierre et Marie Curie, Paris, France

9 Hôpital de l'Archet, Université de Nice-Sophia Antipolis, Nice, France

10 APHM hôpital Ste-Marguerite, Service d'Immuno-hématologie clinique, Marseille, France

11 Institut Cochin, Université Paris-Descartes, INSERM U567-CNRS (UMR 8104), Paris, France

12 APHP, Hôpital Cochin, Service d'Hépatologie, Paris, France

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BMC Health Services Research 2012, 12:59  doi:10.1186/1472-6963-12-59

Published: 12 March 2012

Abstract

Background

Treatment for the hepatitis C virus (HCV) may be delayed significantly in HIV/HCV co-infected patients. Our study aims at identifying the correlates of access to HCV treatment in this population.

Methods

We used 3-year follow-up data from the HEPAVIH ANRS-CO13 nationwide French cohort which enrolled patients living with HIV and HCV. We included pegylated interferon and ribavirin-naive patients (N = 600) at enrolment. Clinical/biological data were retrieved from medical records. Self-administered questionnaires were used for both physicians and their patients to collect data about experience and behaviors, respectively.

Results

Median [IQR] follow-up was 12[12-24] months and 124 patients (20.7%) had started HCV treatment. After multiple adjustment including patients' negative beliefs about HCV treatment, those followed up by a general practitioner working in a hospital setting were more likely to receive HCV treatment (OR[95%CI]: 1.71 [1.06-2.75]). Patients followed by general practitioners also reported significantly higher levels of alcohol use, severe depressive symptoms and poor social conditions than those followed up by other physicians.

Conclusions

Hospital-general practitioner networks can play a crucial role in engaging patients who are the most vulnerable and in reducing existing inequities in access to HCV care. Further operational research is needed to assess to what extent these models can be implemented in other settings and for patients who bear the burden of multiple co-morbidities.

Keywords:
HCV; HIV; Access to care; Alcohol; Primary care