Successful integration of hepatitis C evaluation and treatment services with methadone maintenance

Kenneth A. Harris, Julia H. Arnsten, Alain H. Litwin

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Objectives: Despite high rates of hepatitis C virus (HCV) infection, relatively few current or former injection drug users receive evaluation and treatment for HCV. Here, we demonstrate the feasibility and effectiveness of integrating HCV care and methadone maintenance treatment (MMT). We hypothesized that colocation of these services would result in improved access to and utilization of HCV care. Methods: In this retrospective observational study, all patient charts from a single MMT clinic were reviewed 2 years after HCV care and MMT were integrated. Information obtained included screening for and counseling about HCV infection status, on-site HCV treatment and outcomes, and demographic and substance abuse data. Results: Two hundred ninety-one patient charts were reviewed. Two hundred eighty-one (99%) patients were screened for HCV antibody (HCV-Ab), and 188 (65%) were positive. Forty-nine (17%) patients were HIV/HCV coinfected. Ninety-eight percent of the HCV-Ab-positive patients received HCV counseling. Hundred fifty-nine (85%) of the HCV-Ab-positive patients were eligible to receive further evaluation and treatment for HCV on site, and 125 (78%) accepted. Hundred eighteen (94%) patients were tested for chronic HCV, and 83 were determined to have chronic HCV. Twenty-five patients received liver biopsy; low-stage disease was found in 7 patients. Twenty-one patients initiated HCV treatment. Sustained viral response was achieved in 8 patients. Seventeen patients had contraindications to HCV treatment. Further workup was prevented or delayed in 45 patients for various reasons, most commonly due to personal choice (29 patients). Conclusions: This study demonstrates that current and former injection drug users can be engaged successfully in evaluation and treatment of HCV infection when these services are collocated with MMT.

Original languageEnglish (US)
Pages (from-to)20-26
Number of pages7
JournalJournal of Addiction Medicine
Volume4
Issue number1
DOIs
StatePublished - Mar 2010

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Methadone
Hepatitis C
Hepacivirus
Therapeutics
Virus Diseases
Chronic Hepatitis C
Drug Users
Counseling
Injections
Hepatitis C Antibodies

Keywords

  • Hepatitis C
  • HIV/hepatitis C virus coinfection
  • Injection drug users
  • Methadone maintenance

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Successful integration of hepatitis C evaluation and treatment services with methadone maintenance. / Harris, Kenneth A.; Arnsten, Julia H.; Litwin, Alain H.

In: Journal of Addiction Medicine, Vol. 4, No. 1, 03.2010, p. 20-26.

Research output: Contribution to journalArticle

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abstract = "Objectives: Despite high rates of hepatitis C virus (HCV) infection, relatively few current or former injection drug users receive evaluation and treatment for HCV. Here, we demonstrate the feasibility and effectiveness of integrating HCV care and methadone maintenance treatment (MMT). We hypothesized that colocation of these services would result in improved access to and utilization of HCV care. Methods: In this retrospective observational study, all patient charts from a single MMT clinic were reviewed 2 years after HCV care and MMT were integrated. Information obtained included screening for and counseling about HCV infection status, on-site HCV treatment and outcomes, and demographic and substance abuse data. Results: Two hundred ninety-one patient charts were reviewed. Two hundred eighty-one (99{\%}) patients were screened for HCV antibody (HCV-Ab), and 188 (65{\%}) were positive. Forty-nine (17{\%}) patients were HIV/HCV coinfected. Ninety-eight percent of the HCV-Ab-positive patients received HCV counseling. Hundred fifty-nine (85{\%}) of the HCV-Ab-positive patients were eligible to receive further evaluation and treatment for HCV on site, and 125 (78{\%}) accepted. Hundred eighteen (94{\%}) patients were tested for chronic HCV, and 83 were determined to have chronic HCV. Twenty-five patients received liver biopsy; low-stage disease was found in 7 patients. Twenty-one patients initiated HCV treatment. Sustained viral response was achieved in 8 patients. Seventeen patients had contraindications to HCV treatment. Further workup was prevented or delayed in 45 patients for various reasons, most commonly due to personal choice (29 patients). Conclusions: This study demonstrates that current and former injection drug users can be engaged successfully in evaluation and treatment of HCV infection when these services are collocated with MMT.",
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