Visits to primary care physicians among persons who inject drugs at high risk of Hepatitis C Virus infection: room for improvement

Abstract

Abstract: The role of primary care physicians (PCP) in Hepatitis C Virus (HCV) prevention is increasingly emphasized. Yet, little is known about the patterns of contacts with PCP among persons who inject drugs (PWID). We sought to assess the six-month prevalence of PCP visiting among PWID at risk of HCV infection, and to explore the associated factors. Baseline data were collected from HCV-seronegative PWID recruited in HEPCO, an observational Hepatitis Cohort study (2004-2011) in Montreal, Canada. An interviewer-administered questionnaire elicited information on socio-demographic factors, drug use patterns, and health care services utilization. Blood samples were tested for HCV antibodies. Using the Gelberg-Andersen Behavioral Model, hierarchical logistic regression analyses were conducted to identify predisposing, need and enabling factors associated with PCP visiting. Of the 349 participants (mean age=34; 80.8% male), 32.1% reported visiting a PCP. In the multivariate model, among predisposing factors, male gender (Adjusted Odds Ratio [AOR]=0.45, [0.25-0.83], chronic homelessness (AOR=0.08, [0.01-0.67]), cocaine injection (AOR=0.46, [0.28-0.76]) and reporting greater illegal or semi-legal income (AOR=0.48, [0.27-0.85]) were negatively associated with PCP visits. Markers of need were not associated with the outcome. Among enabling factors, contact with street nurses (AOR=3.86, [1.49-9.90]) and food banks (AOR=2.01, [1.20-3.37]) were positively associated with PCP visiting. Only one third of participating PWID reported a recent visit to a PCP. While a host of predisposing factors seems to hamper timely contacts with PCP among high-risk PWID, community-based support services may play an important role in initiating dialogue with primary health care services in this population.