نبذة مختصرة : Competing Interests: Potential conflicts of interest. The authors declare the following financial interests: S. S. reports receiving honorariums for participation in ad hoc advisory boards for Novo Nordisk. M. B. K. reports grants for investigator-initiated studies from ViiV Healthcare, AbbVie, and Gilead; and consulting fees from ViiV Healthcare, Merck, AbbVie, and Gilead. J. G. reports receiving honorariums for participation in ad hoc advisory boards for ViiV Gilead and Merck. A. W. reports research grants from ViiV HealthCare, AbbVie, and Gilead Sciences and consulting fees from ViiV Healthcare, AbbVie, Merck, and Gilead Sciences. C. C. reports speaker fees, advisor fees and program support from Gilead Sciences, AbbVie, and ViiV Healthcare. J. C. reports grants for investigator-initiated studies from ViiV Healthcare and Gilead and consulting fees from ViiV Healthcare and Gilead. V. M. L. reports research grant from Merck and Gilead and consulting fee from AbbVie. S. W. reports grants for investigator-initiated studies from ViiV Healthcare, Merck, and Gilead and consulting fees and speaking at CME events for ViiV Healthcare, Merck, Gilead and Jannsen. All other authors report no potential conflicts.
Background: The cascade of care, commonly used to assess HIV and hepatitis C (HCV) health service delivery, has limitations in capturing the complexity of individuals' engagement patterns. This study examines the dynamic nature of engagement and mortality trajectories among people with HIV and HCV.
Methods: We used data from the Canadian HIV-HCV Co-Infection Cohort, which prospectively follows 2098 participants from 18 centers biannually. Markov multistate models were used to evaluate sociodemographic and clinical factors associated with transitioning between the following states: (1) lost-to-follow-up (LTFU), defined as no visit for 18 months; (2) reengaged (reentry into cohort after being LTFU); (3) withdrawn from the study (ie, moved); (4) death; otherwise remained (5) engaged-in-care.
Results: A total of 1809 participants met the eligibility criteria and contributed 12 591 person-years from 2003 to 2022. LTFU was common, with 46% experiencing at least 1 episode, of whom only 57% reengaged. One in 5 (n = 383) participants died during the study. Participants who transitioned to LTFU were twice as likely to die as those who were consistently engaged. Factors associated with transitioning to LTFU included detectable HCV RNA (adjusted hazards ratio [aHR], 1.37; 95% confidence interval [CI], 1.13-1.67), evidence of HCV treatment but no sustained virologic response result (aHR, 1.99; 95% CI, 1.56-2.53), and recent incarceration (aHR, 1.94; 95% CI, 1.58-2.40). Being Indigenous was a significant predictor of death across all engagement trajectories.
Interpretation: Disengagement from clinical care was common and resulted in higher death rates. People LTFU were more likely to require HCV treatment highlighting a priority population for elimination strategies.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Processing Request
No Comments.