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TREATMENT OF HEPATITIS C INFECTION FOR CURRENT OR FORMER SUBSTANCE ABUSERS IN A COMMUNITY SETTING
A John-Baptiste1,3, M Varenbut2,3,5, M Lingley6, T Nedd-Roderique3, D Teplin5,7, J Daiter5, M Krahn1,3,4
1Department of Health Policy, Management and Evaluation, 2Department of Family and Community Medicine; 3Faculty of Medicine; 4Faculty of Pharmacy, University of Toronto; 5Ontario Addiction Treatment Centres; 6Round Trip Travel Health Clinic, Markham, Ontario; 7Faculty of Behavioural Sciences, Yorkville University, Fredericton, New Brunswick
The Ontario Addiction Treatment Centres (OATC) operates 26 clinics offering methadone maintenance treatment (MMT) programs for clients with a dependence on substances such as heroin, morphine, oxycodone and codeine. Until recently, MMT was a contraindication to antiviral therapy for the treatment of Hepatitis C virus (HCV) infected patients.
AIM: The purpose of this study was 1) to describe a care model for treating HCV infected MMT clients in a community-based setting, 2) to describe clinical and demographic characteristics of these clients, 3) to assess rates of adherence to antiviral therapy, and 4) to assess rates of sustained virological response (SVR).
METHODS: A review of both paper and electronic medical records was employed. Screening and assessment of clients considered for antiviral therapy was performed over a series of visits during which medical history, physical exam, laboratory testing, diagnostic testing, interview and counseling occurred. Clients considered for antiviral therapy were those thought to have achieved “functional stability”, characterized by stable housing and a low frequency of substance abuse. During treatment, clients were followed by a hepatitis nurse, clinic physician or infectious disease specialist at the clinic where they received methadone. Use of illicit substances was monitored before, during and after antiviral therapy with regular urinalysis.
RESULTS: Between November 2002 and January 2006, 109 clients of the OATC (75 with genotype 1/4 and 33 with genotype 2/3) received at least one injection with pegylated interferon. At intake to the OATC, the majority of clients were single (60%), living in a permanent apartment or house (94%), with a high frequency of self-reported psychiatric disorders (68%). A large proportion had a criminal history (71%) and many had been incarcerated (52%). Rates of adherence to treatment of 57% and 70% were achieved for genotypes 1/4, and 2/3, respectively. Rates of SVR in an intention to treat analysis were 51% for genotypes 1/4 and 64% for genotypes 2/3. A total of 6 clients discontinued therapy due to on-going problems with substance abuse.
CONCLUSION: Antiviral therapy for HCV infection can be successful in the context of specialized care for substance abuse, with rates of adherence and response comparable to non-MMT populations.
Funded by NCRTP-HepC, CLF and CIHR