Hazardous alcohol consumption and other barriers to antiviral treatment among hepatitis C positive people receiving opioid maintenance treatment

Abstract

Amongst people on opioid maintenance treatment (OMT), chronic hepatitis C (HCV) is common but infrequently treated. Numerous barriers, including misuse of alcohol may limit efforts at anti-viral treatment. The aim of this study was to define barriers, including alcohol misuse, to the effective treatment of HCV amongst OMT recipients. Ninety-four OMT patients completed the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). A semi-structured interview was used in 53 subjects to assess alcohol use in detail, psychological health, discrimination and access to HCV treatment. Feasibility of brief intervention for alcohol misuse was assessed. Of the screening participants, 73% reported they were HCV positive. Of the detailed interview participants, 26% reported no drinking in the past month, but 53% scored 8 or more on AUDIT and 42% exceeded NHMRC drinking guidelines. Twenty subjects received brief intervention and among 17 re-interviewed at one month, alcohol consumption fell by 3.1 g/day (p = 0.003). Severe or extremely severe depression, stress and anxiety were found in 57%, 51% and 40% of interviewees respectively. Episodic heavy drinking, mental health problems, perceived discrimination, limited knowledge concerning HCV were all common and uptake of HCV treatment was poor. Brief intervention for alcohol use problems was acceptable to OMT patients, and warrants further study.

Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru

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Are primary health care centres that target injecting drug users attracting and serving the clients they are designed for? A case study from Sydney, Australia

“…Alcohol also increases the risk of overdose when consumed with opioids (Warner-Smith, Darke, Lynskey, & Hall, 2001) and unsafe injecting and sexual behaviours (Rees, Saitz, Horton, & Samet, 2001;Stein et al, 2000). IDUs with alcohol problems are a potential target group for brief alcohol interventions, which have been successfully delivered in similar contexts such as opioid treatment (Watson et al, 2007). Further exploration of the role and outcomes of brief intervention in the IDU-targeted PHC setting may be warranted.…”

Predictors of Alcohol Use Among Rural Drug Users After.Disclosure of Hepatitis C Virus Status

“…Although no additional benefi t was found in "facilitated" educational sessions focused on HCV and liver health compared with "standard" postdiagnostic counseling, these interventions resulted in an overall 22.7% reduction in drinking after 6 months, but there are no data available beyond this time point (Drumright et al, 2011). Other studies of HCV-positive IDUs refl ect the uncertainty of lasting declines in drinking following diagnosis (Stein et al, 2002;Watson et al, 2007), whereas Campbell and colleagues (2006) found high levels of problem drinking despite 84% of their sample reporting awareness of the increased risk of liver disease among HCV-positive individuals who continue to drink. Despite much research, however, the question has yet to be examined outside the context of major urban centers.…”