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Canadian Journal of Gastroenterology
Volume 25 (2011), Issue 3, Pages 135-139
http://dx.doi.org/10.1155/2011/810108
Original Article

Physicians’ Attitudes and Practice Toward Treating Injection Drug Users Infected with Hepatitis C Virus: Results from a National Specialist Survey in Canada

Angelique Myles,1 Gerry J Mugford,2 Jing Zhao,1 Murray Krahn,3,4 and Peizhong Peter Wang1,5

1Division of Community Health and Humanities, Memorial University of Newfoundland, St John’s, Newfoundland and Labrador, Canada
2Clinical Epidemiology Graduate Medicine Program, Faculty of Medicine, Memorial University of Newfoundland, St John’s, Newfoundland and Labrador, Canada
3Department of Medicine and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
4Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
5School of Public Health, Tianjin Medical University, Tianjin, China

Received 2 May 2010; Accepted 27 August 2010

Copyright © 2011 Hindawi Publishing Corporation. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.

Abstract

BACKGROUND: In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care.

OBJECTIVE: To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs.

METHODS: A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes/no), and examined how a physician’s treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service.

RESULTS: Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians’ type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]).

CONCLUSION: The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs.