Abstract
BackgroundFew studies have explored how utilization of outpatient services differ for HIV/HCV coinfected patients compared to HIV or HCV monoinfected patients. The objectives of this study were to (1) compare annual outpatient clinic visit rates between coinfected and monoinfected patients, (2) to compare utilization of HIV and HCV therapies between coinfected and monoinfected patients, and (3) to identify factors associated with therapy utilization.MethodsData were from the 2005–2010 U.S. National Hospital Ambulatory Medical Care Surveys. Clinic visits with a primary or secondary ICD-9-CM codes for HIV or HCV were included. Coinfection included visits with codes for both HIV and HCV. Monoinfection only included codes for HIV or HCV, exclusively. Patients <15 years of age at time of visit were excluded. Predictors of HIV and HCV therapy were determined by logistic regressions. Visits were computed using survey weights.Results3,021 visits (11,352,000 weighted visits) met study criteria for patients with HIV/HCV (8%), HIV (70%), or HCV (22%). The HCV subgroup was older in age and had the highest proportion of females and whites as compared to the HIV/HCV and HIV subgroups. Comorbidities varied significantly across the three subgroups (HIV/HCV, HIV, HCV): current tobacco use (40%, 27%, 30%), depression (32%, 23%, 24%), diabetes (9%, 10%, 17%), and chronic renal failure (<1%, 3%, 5%), (p < 0.001 for all variables). Annual visit rates were highest in those with HIV, followed by HIV/HCV, but consistently lower in those with HCV. HIV therapy utilization increased for both HIV/HCV and HIV subgroups. HCV therapy utilization remained low for both HIV/HCV and HCV subgroups for all years. Coinfection was an independent predictor of HIV therapy, but not of HCV therapy.ConclusionThere is a critical need for system-level interventions that reduce barriers to outpatient care and improve uptake of HCV therapy for patients with HIV/HCV coinfection.
Highlights
Few studies have explored how utilization of outpatient services differ for Human Immunodeficiency Virus (HIV)/hepatitis C virus (HCV) coinfected patients compared to HIV or HCV monoinfected patients
Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) monoinfection have been the subjects of ample research over the past two decades; HIV/HCV coinfection has only recently been documented as a growing medical concern in the United States [1]
Nurses provided care at approximately two-thirds of visits for the HIV/HCV and HIV groups, but only provided care at half of visits for the HCV group (p < 0.001). It was more common for those with HIV/HCV to visit with their primary care provider/physician, as compared to those with either HIV monoinfection or HCV monoinfection
Summary
Few studies have explored how utilization of outpatient services differ for HIV/HCV coinfected patients compared to HIV or HCV monoinfected patients. While antiretroviral and antiviral therapies are widely recommended for use in patients with coinfection [4], these patients continue to experience poorer health outcomes than those with monoinfection. These individuals are at increased risk for accelerated progression of liver disease and increased rates of morbidity and mortality [5,6]. The U.S health care system is based on a multipayer system, whereby, medical care is provided by various independent organizations, rather than a single universal entity These independent organizations are largely owned and operated by the private sector; other players in the market include the U.S government and other non-profit organizations [7]. The multitude of health care providers can result in various barriers to care, including financial barriers for individuals who are uninsured or underinsured, lack of availability of specialized professionals, and inability to reach providers [7]
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