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TREATMENT UPTAKE AND OUTCOMES AMONG INJECTION DRUG USERS (IDUS) IN A MULTIDISCIPLINARY PROGRAM FOR THE TREATMENT OF HEPATITIS C VIRUS (HCV) INFECTION
KA Genoway1, J Grebely1,3, F Duncan3, M Viljoen3, L Gallagher3, D Elliott3, M Khara3, M Raffax2, S deVlaming3, B Conway1,3
1Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia; 2Department of Statistics and Actuarial Science, University of Waterloo; 3Pender Community Health Centre, Vancouver Coastal Health, Vancouver
AIM: We evaluated HCV treatment uptake and outcomes among current and former IDUs attending a weekly peer-support group and receiving directly observed HCV therapy (DOT).
METHODS: Beginning in March 2005, patients interested in receiving treatment for HCV infection were referred to a weekly peer-support group and evaluated for treatment. Utilizing the existing infrastructure for addiction disease management, we have developed a model whereby the treatment of addiction, HCV and other medical conditions are integrated under the DOT model of care. Patients received directly observed therapy with pegylated interferon alpha 2a or alpha 2b (PEG-IFN alpha 2a or alpha 2b), both in combination with self-administered ribavirin (RBV).
RESULTS: Overall, 129 subjects were referred to the support group over a period of 108 weeks, with the mean attendance being 15 subjects per week (range 3-32). Overall, 10 (8%) did not medically qualify for treatment, 39 (30%) were lost to follow-up and 8 (6%) had completed or initiated treatment for HCV infection prior to attending the group. We observed a high uptake of HCV treatment among attendees, with 30% of subjects (39/129) currently under evaluation and 26% (33/129) having initiated or completed treatment for HCV infection. In a comparison of subjects that had initiated or completed treatment for HCV infection (n=33) and those lost to follow up (n=39), those having received treatment for HCV infection had a higher median attendance [34 meetings (Interquartile range, IQR = 11-33) vs. 2 meetings (IQR=1-3, P<0.001)] and were more likely to attend >3 clinic visits (97% vs. 23%, P<0.001) than those lost to follow up. To date, 31 patients (PEG-IFN alpha 2a/RBV = 15; PEG-IFN alpha 2b/RBV = 4) have initiated treatment for HCV infection at our site and 18 have completed therapy, with 67% (12/18) of subjects achieving an end of treatment response (Genotype 1 – 40%, Genotypes 2 – 100%, Genotype 3 – 67%), despite ongoing drug use in 72% of patients during treatment.
CONCLUSION: With the appropriate programs in place, a high uptake and response to HCV treatment can be achieved among IDUs.