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241

HEPATITIS C CARE IN A COMMUNITY BASED LOW THRESHOLD METHADONE PROGRAM: INITIAL EXPERIENCE

J Fraser¹, A Martin¹, C MacIssac¹, C Burgess², G Hirsch², KM Peltekian^2
1Direction 180; ²Hepatology Services, Capital District Health Authority, Halifax, NS

Injection drug user (IDU) population make up a large portion of clients infected with hepatitis C virus (HCV) HCV treatment studies in active IDUs have results comparable to clinical trials in non-IDUs Our objective was to review a “real world” experience in a community based low threshold methadone (MMD) clinic treating clients infected with HCV as part of their recovery program that included comprehensive education by healthcare staff and mentoring by peers
In late 2004, review of all clients at Direction 180 identified 70% to be infected with HCV. Nursing capacity allowed only treatment of 10% of clients annually focusing on those with more advanced disease but no signs of decompensation and willingness to adhere to the antiviral regimen (pegylated interferon alpha-2b and ribavirin). All interferon injections were administered by members of the healthcare staff, and the morning dose of the ribavirin was witnessed by the same staff. The clients self administered their pm dose of ribavirin. The table below describes the first 7 clients treated with week 12 (EVR) and 6 months post treatment (SVR) responses:
                                                                        

ID #	Genotype	MMD	IDU/Other	EVR	SVR
162	3a	30 mg	no/yes	yes	yes
139	3a	150 mg	no/yes	yes	yes
141	3a	120 mg	no/yes	yes	yes
034	1	120mg	no/yes	no	n/a
285	3	130 mg	no/yes	Lost for f/u	n/a
298	1a	120 mg	no/yes	yes	yes
276	3	75 mg	no/yes	yes	yes
321	3	150 mg	no/yes	Rx stopped	n/a

One client stopped therapy at week 3 due to psychological side effects; in another, therapy was discontinued because of no EVR. One was lost for follow up. None received prescribed antidepressant and/or antipsychotic medications. During follow up, none has been re-infected with HCV.
CONCLUSION: The sample size in this study is small but it provides “real world” experience and hope that HCV antiviral therapy may behave positive outcomes for healthcare staff and for clients in a difficult environment with limited capacity.

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