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BACKGROUND: The Medical Monitoring Project (MMP) is a federal surveillance project designed to produce nationally representative data on people living with HIV/AIDS (PLWH) and in care. MMP has two components: an interview and medical record abstraction. Though regular hepatitis C testing is recommended for PLWH, there are no estimates of hepatitis C testing among PLWH in Washington State. This analysis describes HIV and hepatitis C co-infection and hepatitis C screening rates among PLWH in care using Washington State MMP interview and medical record data.
METHODS: MMP data from years 2009-2011 were used for this analysis. Patient interviews were used to describe patient demographics, medical history, use of medical and social services and risk behaviors. Hepatitis C screening data were obtained from the medical record abstraction. For this analysis, an individual was considered to be co-infected with HIV and hepatitis C if he/she had evidence of ever having a positive hepatitis C test in the medical chart, and did not have a subsequent documented negative test result. Descriptive statistics and statistical significance were obtained using chi square tests.
RESULTS: In 2009-2011, 14.5% of HIV-positive persons in care in Washington were co-infected with hepatitis C. Of these individuals, 72% received their HIV diagnoses prior to receiving their hepatitis C diagnoses. Relative to the HIV mono-infected group, the HIV/hepatitis C co-infected group were significantly older (p<0.027), less educated (p<0.0001), had less income (p<0.0001), and needed more help understanding health materials (p<0.005). Common features across the two groups included race/ethnicity, birth sex, unmet need for supportive services and medication adherence. Approximately 21% of HIV-infected persons in care had no evidence of ever being tested for hepatitis C. Approximately 6% of this group reported injection drug use and 34% reported alcohol use in the past 12 months. Relative to the screened population, a higher proportion of unscreened individuals were below the Federal Poverty Level (p<0.002).
CONCLUSIONS: A large percentage of PLWH in care in Washington have not received hepatitis C screening. Relative to the HIV mono-infected population, the HIV/hepatitis C co-infected population was less educated and required more assistance with understanding health materials. These are traits that may prevent unscreened individuals, who are also unknowingly co-infected, from directing their health care and seeking hepatitis C testing. HIV care providers should offer hepatitis C screening to all of their HIV-infected patients, including older established patients, and should offer additional assistance to individuals with limited education.