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

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.

Keywords: HIV/hepatitis C virus coinfection; hepatitis C; injection drug users; methadone maintenance.

FIGURE 1

Site of hepatitis C virus (HCV) evaluation for HCV antibody-positive patients, n = 188.

FIGURE 2

Outcomes of on-site hepatitis C virus (HCV) evaluation and treatment, n = 125. Shaded boxes comprise the 45 patients who reached a primary goal for completion of the HCV evaluation process.

FIGURE 3

Outcomes of off-site HCV evaluation and treatment, n = 63; 34 patients were eligible for on-site HCV care but chose to receive care elsewhere, and 29 patients were not eligible for on-site care because of their health insurance coverage.