Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada.

BACKGROUND: Treatment of hepatitis c virus (HCV) with direct-acting-antivirals (DAAs) by family physicians in primary care and addiction settings may allow treatment expansion to inner-city populations, including people who inject drugs (PWID). Real-world data however, suggests high rates of non-attendance to SVR 12 testing. This study examines outcomes of HCV treatment delivered by family physicians working in interdisciplinary treatment programs, integrated into inner-city primary care clinics. METHODS: In this prospective cohort, participants completed baseline questionnaires, including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR 12) if HCV RNA was undetectable 12 weeks following end of therapy, and were recorded as lost to follow-up (LTFU) if they did not present for an HCV follow-up visit. SVR was calculated in intention to treat (ITT) as well as modified intention to treat (mITT) analysis, which excluded those who completed treatment but had no SVR 12 result. A logistic regression model assessed factors associated with LTFU. RESULTS: Of 138 individuals included in the analysis, 52% were on opioid agonist therapy (OAT), 75% reported a history of injection drug use (IDU), with 25% reporting IDU in the month prior to treatment initiation. ITT SVR across all sites and genotypes was 86% and mITT was 95%. There was a significant difference in mITT for those reporting recent IDU compared to those who did not (87% vs 99% p = 0.03). While 13% were LTFU at SVR 12, participants receiving OAT in the same clinic as HCV treatment were less likely to be LTFU (aOR 0.09(0.02-0.46)). CONCLUSION: HCV treatment by family physicians, along with interdisciplinary teams, can be successful in inner-city populations in the era of DAAs; however, follow-up after treatment is a challenge. Integrating OAT in the same location as HCV treatment may help to improve follow-up.

An exploration of crossover sexual offending.

Studies have produced equivocal findings regarding whether sex offenders are stable in their choice of victims. Indeed, it remains unclear whether a sex offender's subsequent victims are typically of the same gender, age range, and victim-perpetrator relationship as that of the initial victim. Although some differences may be attributed to methodological disparities, others are not. This study sought to clarify this question by examining the tendency of sex offenders to switch from one type of victim to another, both within an index offense and across offenses and all victims. Archival records of 789 incarcerated sex offenders were examined. Of those offenders who had multiple victims at the index offense (n = 279), 13% had victims of both genders, 14% had victims in different age categories (child, adolescent, and adult), and 13% had varying relationships with the victims (i.e., family member, acquaintance, or stranger). When the records of those with past sexual convictions were examined (n = 208), 20% of offenders had a prior victim of a different gender; 40% crossed over across age categories, and 48% of the repeat offenders had varying relationships with the victim across convictions. Offenders who had both male and female victims and offenders who had victims of varied relationship status across crimes had higher Static-99 risk scores than offenders who were more stable with regard to victim selection. These findings are compared to those of previous studies, focusing on how these results add clarity to a previous literature whose conclusions were challenged by the use of disparate sampling and research methodologies.