{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:30:26Z","timestamp":1785731426501,"version":"3.56.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000156","name":"Fonds de Recherche du Qu\u00e9bec - Sant\u00e9","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000156","id-type":"DOI","asserted-by":"publisher"}]},{"name":"R\u00e9seau sida\/maladies infectieuses"},{"DOI":"10.13039\/501100000024","name":"Canadian Institute for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"name":"CIHR Canadian HIV Trials Network"},{"name":"Queen\u2019s Research Initiation Grant"},{"name":"Canadian Network on Hepatitis C"},{"name":"CanHepC"},{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]},{"name":"chercheur de m\u00e9rite award"},{"DOI":"10.13039\/501100001804","name":"Canada Research Chairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001804","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Tier 2 Canada Research Chair"},{"name":"Tier I Canada Research Chair"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The cascade of care, commonly used to assess HIV and hepatitis C (HCV) health service delivery, has limitations in capturing the complexity of individuals\u2019 engagement patterns. This study examines the dynamic nature of engagement and mortality trajectories among people with HIV and HCV.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u20131.67), evidence of HCV treatment but no sustained virologic response result (aHR, 1.99; 95% CI, 1.56\u20132.53), and recent incarceration (aHR, 1.94; 95% CI, 1.58\u20132.40). Being Indigenous was a significant predictor of death across all engagement trajectories.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofae239","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T17:57:04Z","timestamp":1714067824000},"source":"Crossref","is-referenced-by-count":7,"title":["Frequent Disengagement and Subsequent Mortality Among People With HIV and Hepatitis C in Canada: A Prospective Cohort Study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0224-379X","authenticated-orcid":false,"given":"Sahar","family":"Saeed","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences, Queen's University , Kingston, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Queen's University , Kingston, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duy A","family":"Dinh","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Queen's University , Kingston, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Moodie","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, McGill University , Montreal, Quebec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cox","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, McGill University , Montreal, Quebec , Canada"},{"name":"Department of Medicine, University of Ottawa , Ottawa, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Calgary , Calgary, Alberta , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centre de recherche du Centre hospitalier de l'Universit\u00e9 Montr\u00e9al , Montreal, Quebec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Martel-Laferriere","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centre de recherche du Centre hospitalier de l'Universit\u00e9 Montr\u00e9al , Montreal, Quebec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Panagiotoglou","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, McGill University , Montreal, Quebec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Walmsley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Health Network , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine, Regina Qu\u2019Appelle Health Region , Regina, Saskatchewan , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina B","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases\/Chronic Viral Illness Service , McGill University Health Center, Quebec , Canada"},{"name":"Canadian HIV Trials Network , Vancouver, British Columbia , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"2024053113415508900_ofae239-B1","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/S1473-3099(15)00485-5","article-title":"Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis","volume":"16","author":"Platt","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2024053113415508900_ofae239-B2","volume-title":"I-Track: enhanced surveillance of HIV, hepatitis C and associated risk behaviours among people who inject drugs in Canada. 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