Integrating Hepatitis C Services into Existing HIV Services: The Experiences of a Sample of U.S. Drug Treatment Units

Abstract

Hepatitis C virus (HCV) is the most prevalent blood-borne infectious disease in the United States, especially among drug users, and coinfection with HIV is common. Because drug users are often medically underserved, drug treatment units are important sites of opportunity for providing services for these infectious diseases. Given the commonalities in the routes of transmission of HIV and HCV, and the fact that many drug treatment units have established an infrastructure to provide HIV services, some have suggested integrating HCV services into those already established for HIV. Using data collected in a telephone survey with 89 drug treatment units throughout the United States, this paper examines the extent to which drug treatment units have expanded their HIV services to include those for HCV, and the extent to which this expansion was facilitated by having HIV services in place. Overall, a greater proportion of methadone maintenance than drug-free treatment units provided services for HIV and HCV. The majority of units in both modalities that provided HIV- and HCV-related services expanded their HIV service delivery to include similar HCV services, and one third expanded all of their HIV services. A large number of these units, however, indicated that having an HIV service infrastructure did not facilitate this expansion, often because the units wanted to emphasize differences in the two viral infections. Policy makers and individual treatment units need to develop strategies that capitalize on existing infrastructures while maintaining the distinction between HIV and HCV primary and secondary prevention efforts.

Structural Interventions: Concepts, Challenges and Opportunities for Research

“…52 Other initiatives attempt to expand HIV care services for drug users to address their needs for Hepatitis C services, including integrating HCV screening into HIV testing and outreach programs and in HIV care specialty clinics and developing hospital-based hepatitis clinics. 53,54 Integrating HIV care and reproductive health services potentially can increase the availability and use of both types of services. Strategies for effective service integration and the impact of such integration on reproductive health outcomes, such as preventing HIV transmission to infected partners or re-infection of infected partners and unintended pregnancy are unknown.…”

Psychiatric behavioral aspects of comanagement of hepatitis C virus and HIV

“…One strategy to reduce the barriers to accessing treatment for HCV has been to colocate HCV treatment services at existing sites of treatment and residential placement of persons who are HIV-positive. Treatment models have been proposed at methadone maintenance treatment programs [33], prisons [34], and HIV primary care sites [35]. An additional model under development is the adaptation of directly observed therapy programs to treat HCV in coinfected injection drug users [36].…”

Changing Treatment Paradigms: Hepatitis C Virus in HIV-Infected Patients

“…One mechanism in which a multidisciplinary approach is already operative and which can be used to expand access to HCV treatment is to integrate HCV treatment into comprehensive HIV treatment programs such as those directed toward injection drug users. 117 An additional issue is the need to find more effective HCV treatments than pegylated interferon and ribavirin. While preliminary results with HCV-specific therapies are very promising, US Food and Drug Administration approval of these agents is not expected for at least three years in monoinfected patients.…”