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Dominique Salmon-Ceron, Julien Cohen contributed equally to this work.
DSC, JC, MW, FBS, MAL, PR, MM, FD, BS, and MPC has no competing interests to declare. PS was invited at Board, workshop participations or meeting of Gilead, Bristol-Myers Squibb, Schering-Plough/MSD, Roche, Janssen. He was Sub-investigator in HCV trials: Bristol-Myers Squibb, Roche, Schering-Plough/MSD, Boehringer Ingelheim, Tibotec, Vertex, Janssen IPM was invited at Board, workshop participations or meeting invitations: Gilead, Bristol-Myers Squibb, Schering-Plough/MSD, Roche, Janssen, Viiv health care, Abbott, Boehringer Ingelheim She was sub-investigator in HIV and HCV trials: Bristol-Myers Squibb, Roche, Schering-Plough/MSD, Boehringer Ingelheim, Tibotec, Gilead, Viiv Health care, Abbott ER received honoraria from Roche and Schering-Plough.
DSC is the main investigator of the cohort, wrote the first draft of the introduction and of the discussion of the manuscript. JC performed the statistical analysis, wrote the methods and the results of the first draft of the manuscript and followed the different revisions of the manuscript before its acceptance. MW and MAL contributed to the methods section and revised the whole manuscript. PR, FD, FBS, PS, BS, MM contributed to the different revisions of the whole manuscript. ER, IPM were investigators of the study and contributed to the discussion of the results. MPC coordinated the data analysis strategy, contributed to the introduction and the discussion, revised the final manuscript and followed the different revisions of the manuscript before its acceptance. All authors read and approved the final manuscript.
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.
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.
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.
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.