Andreea Adelina Artenie1, Élise Roy2, Geng Zang3, Didier Jutras-Aswad4, Jean-Marie Bamvita3, Svetlana Puzhko1, Mark Daniel5, Julie Bruneau6. 1. Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1. 2. Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, Canada J4K 0A8; Institut National de Santé Publique du Québec, 190 Crémazie E, Montréal, QC, Canada H2P 1E2. 3. Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9. 4. Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Psychiatry, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-ville, Montréal, QC, Canada H3C 3J7. 5. School of Population Health, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia. 6. Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-ville, Montréal, QC, Canada H3C 3J7. Electronic address: julie.bruneau@umontreal.ca.
Abstract
BACKGROUND: Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP). METHODS: A prospective cohort study, HEPCO, was conducted among active PWID in Montréal (2004-2013). Interviews scheduled at 3- or 6-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence. RESULTS: At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0-21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% CI: 0.31-0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection. CONCLUSION: Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention.
BACKGROUND: Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP). METHODS: A prospective cohort study, HEPCO, was conducted among active PWID in Montréal (2004-2013). Interviews scheduled at 3- or 6-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence. RESULTS: At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0-21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% CI: 0.31-0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection. CONCLUSION: Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention.