Factors associated with successful referral for clinical care of drug users with chronic hepatitis C who have or are at risk for HIV infection

Dawn A. Fishbein, Yungtai Lo, John F. Reinus, Marc N. Gourevitch, Robert S. Klein

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

The objective of this study was to determine outcomes of referring drug users (DUs) with chronic hepatitis C for clinical evaluation and care. Two hundred twenty-eight persons with detectable hepatitis C virus RNA were given expedited referrals for evaluation and possible treatment of hepatitis C from a prospective study cohort of current and former opiate-addicted DUs. Four outcomes were analyzed: accepted referral, arrived for clinical evaluation, had liver biopsy, and received treatment. One hundred twenty-seven participants (56%) accepted referral, of whom 54 (43%) arrived for evaluation. Of these participants, 12 (22%) had liver biopsy, and 4 (7%) were treated. Multivariate logistic regression revealed that HIV-infected DUs were significantly less likely to accept referral (adjusted odds ratio [ORadj], 0.51; 95% confidence interval [CI], 0.30-0.88), and older participants were more likely to keep an appointment (ORadj, 1.06/y; 95% CI, 1.00-1.12). Of HIV-seropositive participants, those with a history of injection were more likely to accept referral (ORadj, 3.60; 95% CI, 1.08-11.96), and those with higher HIV load (ORadj, 0.50/log10; 95% CI, 0.26-0.94) and Hispanic ethnicity (ORadj, 0.26; 95% CI, 0.07-0.89) were less likely to keep an appointment. Despite expedited referrals for hepatitis C care, only a few participants received an evaluation, and even far fewer were treated. Because increasingly effective treatment is available, better methods are urgently needed to improve evaluation and treatment of HCV-infected DUs, including those coinfected with HIV.

Original languageEnglish (US)
Pages (from-to)1367-1375
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume37
Issue number3
DOIs
StatePublished - Nov 1 2004

Fingerprint

Chronic Hepatitis C
Drug Users
HIV Infections
Referral and Consultation
Confidence Intervals
HIV
Hepatitis C
Opiate Alkaloids
Appointments and Schedules
Biopsy
Liver
Therapeutics
Hispanic Americans
Hepacivirus
Logistic Models
Odds Ratio
Prospective Studies
RNA
Injections

Keywords

  • Drug users
  • Hepatitis C
  • HIV
  • HIV/hepatitis C virus (HCV) coinfection
  • Treatment referral

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Factors associated with successful referral for clinical care of drug users with chronic hepatitis C who have or are at risk for HIV infection. / Fishbein, Dawn A.; Lo, Yungtai; Reinus, John F.; Gourevitch, Marc N.; Klein, Robert S.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 37, No. 3, 01.11.2004, p. 1367-1375.

Research output: Contribution to journalArticle

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abstract = "The objective of this study was to determine outcomes of referring drug users (DUs) with chronic hepatitis C for clinical evaluation and care. Two hundred twenty-eight persons with detectable hepatitis C virus RNA were given expedited referrals for evaluation and possible treatment of hepatitis C from a prospective study cohort of current and former opiate-addicted DUs. Four outcomes were analyzed: accepted referral, arrived for clinical evaluation, had liver biopsy, and received treatment. One hundred twenty-seven participants (56{\%}) accepted referral, of whom 54 (43{\%}) arrived for evaluation. Of these participants, 12 (22{\%}) had liver biopsy, and 4 (7{\%}) were treated. Multivariate logistic regression revealed that HIV-infected DUs were significantly less likely to accept referral (adjusted odds ratio [ORadj], 0.51; 95{\%} confidence interval [CI], 0.30-0.88), and older participants were more likely to keep an appointment (ORadj, 1.06/y; 95{\%} CI, 1.00-1.12). Of HIV-seropositive participants, those with a history of injection were more likely to accept referral (ORadj, 3.60; 95{\%} CI, 1.08-11.96), and those with higher HIV load (ORadj, 0.50/log10; 95{\%} CI, 0.26-0.94) and Hispanic ethnicity (ORadj, 0.26; 95{\%} CI, 0.07-0.89) were less likely to keep an appointment. Despite expedited referrals for hepatitis C care, only a few participants received an evaluation, and even far fewer were treated. Because increasingly effective treatment is available, better methods are urgently needed to improve evaluation and treatment of HCV-infected DUs, including those coinfected with HIV.",
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