Provider and Patient Correlates of Provider Decisions to Recommend HCV Treatment to HIV Co-Infected Patients

Abstract

Despite low uptake of HCV treatment among HIV co-infected patients, few studies have examined the factors that contribute to provider decisions to recommend treatment. Surveys of 173 co-infected patients and their primary care providers, as well as patient chart data, were collected at three HIV clinics in Los Angeles; 73% of the patients had any history of being recommended HCV treatment. Multivariate predictors of being offered treatment included being Caucasian, greater HCV knowledge, receiving depression treatment if depressed, and one's provider having a lower weekly patient load and more years working at the study site. These findings suggest that provider decisions to recommend HCV treatment are influenced by patient factors including race and psychosocial treatment readiness, as well as characteristics of their own practice and treatment philosophy. With changes to HCV treatment soon to emerge, further evaluation of factors influencing treatment decisions is needed to improve HCV treatment uptake.

Patient Characteristics Associated with HCV Treatment Adherence, Treatment Completion, and Sustained Virologic Response in HIV Coinfected Patients

“…Findings regarding factors associated with provider recommendation of treatment [31], and patient acceptance and initiation of treatment [32], have been reported elsewhere. In this paper we report analyses on the data from the subgroup of 72 treated patients.…”

Conceptual framework for outcomes research studies of hepatitis C: an analytical review

“…The data source in the majority of US studies was the Veterans Health Administration. Two US studies used health insurance claims data, 36 , 37 one used data from several HIV clinics, 38 and two were epidemiologic studies ( Table 2 ). 39 , 40 Antiviral treatment and SVR were the two outcome variables measured most frequently ( Table 2 ).…”

“… 36 c The main outcome variable was offering HCV antiviral treatment in HIV-coinfected patients. 38 d Defined as the scheduling of an appointment to see a specialist in gastroenterology or infectious disease, whether or not the patient attended. e Liver biopsy not limited to patients with genotype 1.…”

“…The predictor variables listed are those included in multivariate analyses in the various studies (not every variable measured in univariate analyses). a Wagner et al 38 focuses on predictors of being offered HCV treatment. b There were no studies that exclusively looked at treatment monitoring (all of the listed studies looked at treatment monitoring as the composite of individual process-of-care measures).…”

“…Providers responded on a 5-point Likert scale, ranging from “very likely” to “very unlikely”. 38 f Refers to round of treatment (treatment naïve versus retreatment). g Presented multivariate analyses for chronic HCV patients with genotype 1 treated with boceprevir and telaprevir.…”