Background
Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) monoinfection have been the subjects of ample research over the past two decades; however, HIV/HCV coinfection has only recently been documented as a growing medical concern in the United States. Combination HIV antiretroviral therapy and combination HCV antiviral therapy have been recommended since the late 1990s, as they each greatly reduce patient morbidity and mortality. While antiretroviral and antiviral therapies are widely recommended for use in patients with coinfection, these patients continue to experience poorer health outcomes than those with monoinfection. For instance, these individuals are at increased risk for accelerated progression of liver disease and increased rates of morbidity and mortality.
If patients with coinfection do not utilize outpatient services to the extent that patients with HIV or HCV utilize these services, consequently, patients with coinfection may not be prescribed therapy to the extent that patients with monoinfection are prescribed therapy. Few studies to date have explored how outpatient health care utilization patterns differ by infection status. Thus, the extent to which patients with coinfection receive care in the U.S. outpatient health care delivery system, as compared to patients with monoinfection, is relatively unknown. The U.S. health care system is based on a multi-payer 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; however, other players in the market include the U.S. government and other non-profit organizations. 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.
The objectives of this study were to compare, between patients with HIV/HCV coinfection and monoinfection (HIV and HCV), (1) annual outpatient clinic visit rates, (2) trends in yearly outpatient prescription for HCV antiviral therapy and HIV antiretroviral, (3) conduct multivariate analysis to identify factors associated with antiretroviral and antiviral utilization.