Toward Integrated Care for Hepatitis C Infection and Addiction

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Toward Integrated Care for Hepatitis C Infection and Addiction

There is an opportunity to improve HCV treatment rates for people who inject drugs by integrating DAA therapy into current models of community-based addiction.

The World Health Organization’s global strategy on viral hepatitis aims to reduce new infections by 90% by 2030.1 To meet that goal, increased effort is needed to engage people who inject drugs (PWID). Although the estimated prevalence of hepatitis C virus (HCV) in this population is 50%, HCV treatment uptake is low despite high treatment willingness and comparable treatment outcomes between PWID and the general population.

“This is concerning, as lack of access to treatment among PWID may lead to a massive untreated and viremic population at risk of progressing to end-stage-liver disease, increasing the burden on the healthcare system, as well as furthering HCV transmission,” according to a 2018 paper published in the International Journal of Drug Policy.1

Numerous studies have demonstrated the benefits of integrated care to address both infectious diseases and substance use disorders in this group.2-4 Compared with more formal treatment settings such as specialist clinics and hospitals, the “integrated, community-based addiction treatment and care models may provide easier access to care and may improve HCV treatment uptake.”

There is an opportunity to improve HCV treatment rates for PWID by integrating direct-acting antiviral (DAA) therapy into current models of community-based addiction. In a study at a center in England that integrated HCV care into a substance abuse treatment setting, 69% of participants were drug users and 47% had mental illness.3 Of the 87 patients who initiated treatment, 98% complied with treatment and 87% achieved a sustained virologic response.

Other findings support the potential benefits of integrated opioid agonist therapy and HCV care models led by community pharmacists, with increased screening, follow-up, and treatment compliance.5 “Ultimately, the redesign of addiction treatment programs to address HCV should consider the overall health of PWID to reduce harms and prevent HCV infection and reinfection,” wrote authors of recent article.1 “Key access points where PWID frequent which integrate HCV care and prevent leakage from the cascade of care with point-of-care diagnostics and treatment, such as in community pharmacies, addiction treatment support groups, and needle distribution programs, should be explored.”

Read on: Toward Integrated Care for Hepatitis C Infection and Addiction

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