Rising Number of Patients Living With HIV Miss Hepatitis C Intake Appointments

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There are several factors associated with failure to attend HCV intake appointments, including current substance use and a history mental health disorder.
There are several factors associated with failure to attend HCV intake appointments, including current substance use and a history mental health disorder.

The percentage of people living with HIV who miss hepatitis C virus (HCV) intake appointments is on the rise in the United States, according to study results published in Open Forum Infectious Diseases.

The results indicated that there are several factors associated with failure to attend HCV intake appointments, including current substance use and a history of a mental health disorder (MHD).

The researchers used logistic regression analyses to identify factors associated with missed HCV intake appointments and failure to establish HCV care in participants living with HIV who were referred for HCV treatment between January 2014 and December 2017. Variables included demographic information, HIV treatment characteristics, type of insurance, liver health status, active alcohol/illicit drug use, unstable housing, and history of MHD.

During the study period, the researchers documented 349 new scheduled HCV clinic appointments for 202 distinct participants. Of these participants, approximately half were non-white, 80% had an undetectable HIV viral load, 31.7% reported drug use, 32.8% reported heavy alcohol use, and 37.8% had MHD.

Over the course of the 4-year study period, 21.9% of participants referred for HCV treatment missed their HCV intake appointment. This percentage increased each year from 17.2% in 2014 to 25.4% in 2017 (P =.021).

Of the 202 newly-referred HCV patients, 32.7% (n=66) missed their first HCV appointment, and 42.4% (n=28) of these participants failed to establish HCV care.

The researchers found that several factors were independent predictors of missing an HCV intake appointment, including a history of MHD, CD4 <200, ongoing drug use, and being non-white. The strongest independent predictor of failure to establish HCV care was a detectable HIV viral load.

“Scaling up integration of mental health and substance use treatment services into HIV/HCV care should be routine and is essential to achieving HCV elimination,” the researchers wrote.

Reference

Cachay ER, Hill L, Torriani F, et al. Predictors of missed hepatitis C intake appointments and failure to establish hepatitis C care among patients living with HIV [published online July 31, 2018]. Open Forum Infect Dis. doi:10.1093/ofid/ofy173

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