{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T01:30:46Z","timestamp":1775871046810,"version":"3.50.1"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fonds de recherche du Qu\u00e9bec \u2013Sant\u00e9; R\u00e9seau sida\/maladies infectieuses"},{"DOI":"10.13039\/501100000024","name":"Canadian Institute for Health Research","doi-asserted-by":"crossref","award":["FDN-143270"],"award-info":[{"award-number":["FDN-143270"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"name":"CIHR Canadian HIV Trials Network","award":["CTN222"],"award-info":[{"award-number":["CTN222"]}]},{"name":"Tier 1 Canada Research Chair"},{"name":"Canadian Network for Hepatitis C"},{"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"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>HIV-HCV coinfected individuals are often more deprived than the general population. However, deprivation is difficult to measure, often relying on aggregate data which does not capture individual heterogeneity. We developed an individual-level deprivation index for HIV-HCV co-infected persons that encapsulated social, material, and lifestyle factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We estimated an individual-level deprivation index with data from the Canadian Coinfection Cohort, a national prospective cohort study. We used a predetermined process to select 9 out of 19 dichotomous variables at baseline visit to include in the deprivation model: income &gt;$1500\/month; education &gt;high school; employment; identifying as gay or bisexual; Indigenous status; injection drug use in last 6 months; injection drug use ever; past incarceration, and past psychiatric hospitalization. We fitted an item response theory model with: severity parameters (how likely an item was reported), discriminatory parameters, (how well a variable distinguished index levels), and an individual parameter (the index). We considered two models: a simple one with no provincial variation and a hierarchical model by province. The Widely Applicable Information Criterion (WAIC) was used to compare the fitted models. To showcase a potential utility of the proposed index, we evaluated with logistic regression the association of the index with non-attendance to a second clinic visit (as a proxy for disengagement) and using WAIC compared it to a model containing all the individual parameters that compose the index as covariates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We analyzed 1547 complete cases of 1842 enrolled participants. According to the WAIC the hierarchical model provided a better fit when compared to the model that does not consider the individual\u2019s province. Values of the index were similarly distributed across the provinces. Overall, past incarceration, education, and unemployment had the highest discriminatory parameters. However, in each province different components of the index were associated with being deprived reflecting local epidemiology. For example, Saskatchewan had the highest severity parameter for Indigenous status while Quebec the lowest. For the secondary analysis, 457 (30%) failed to attend a second visit. A one-unit increase in the index was associated with 17% increased odds (95% credible interval, 2% to 34%) of not attending a second visit. The model with just the index performed better than the model with all the components as covariates in terms of WAIC.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>We estimated an individual-level deprivation index in the Canadian Coinfection cohort. The index identified deprivation profiles across different provinces. This index and the methodology used may be useful in studying health and treatment outcomes that are influenced by social disparities in co-infected Canadians. The methodological approach described can be used in other studies with similar characteristics.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0249836","type":"journal-article","created":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T18:25:29Z","timestamp":1618856729000},"page":"e0249836","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Estimating an individual-level deprivation index for HIV\/HCV coinfected persons in Canada"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1904-5730","authenticated-orcid":true,"given":"Adam","family":"Palayew","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra M.","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar","family":"Saeed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Curtis L.","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9rie","family":"Martel-Laferri\u00e8re","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Walmsley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7041-1556","authenticated-orcid":true,"given":"Joseph","family":"Cox","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina B.","family":"Klein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Canadian Coinfection Cohort Study Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,19]]},"reference":[{"issue":"1","key":"pone.0249836.ref001","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/j.1468-1293.2012.01028.x","article-title":"HIV and hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality","volume":"14","author":"MB Klein","year":"2013","journal-title":"HIV Med"},{"issue":"3","key":"pone.0249836.ref002","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/MOG.0000000000000347","article-title":"Update in HIV-hepatitis C virus coinfection in the direct acting antiviral era","volume":"33","author":"EG Meissner","year":"2017","journal-title":"Curr Opin Gastroenterol"},{"issue":"2","key":"pone.0249836.ref003","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1017\/S0047279400020341","article-title":"Deprivation","volume":"16","author":"P Townsend","year":"1987","journal-title":"Journal of Social Policy"},{"issue":"3","key":"pone.0249836.ref004","first-page":"10","article-title":"A Deprivation Index for Health and Welfare Planning in Quebec","volume":"21","author":"R Pampalon","year":"2000","journal-title":"Chronic Diseases in Canada"},{"issue":"2","key":"pone.0249836.ref005","article-title":"An Area-based Material and Social Deprivation Index for Public Health in Qu\u00e9bec and Canada","volume":"103","author":"R Pampalon","year":"2012","journal-title":"Can J Public Health"},{"issue":"2","key":"pone.0249836.ref006","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.healthplace.2009.11.012","article-title":"Health inequalities in urban and rural Canada: comparing inequalities in survival according to an individual and area-based deprivation index","volume":"16","author":"R Pampalon","year":"2010","journal-title":"Health Place"},{"issue":"8","key":"pone.0249836.ref007","doi-asserted-by":"crossref","first-page":"e0183609","DOI":"10.1371\/journal.pone.0183609","article-title":"A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV\/HCV infections in British Columbia","volume":"12","author":"ZA Butt","year":"2017","journal-title":"PLoS One"},{"key":"pone.0249836.ref008","unstructured":"Pampalon R, Hamel D, Gamache P. 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