Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

Abstract

Background A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era. Methods We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island’s only nonprofit methadone maintenance program. Results Of 275 who initiated DAAs, the mean age (range) was 43 (22–71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25–202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45–120 minutes per patient. Conclusions DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.

The risk of hepatitis C virus recurrence in hepatitis C virus‐infected patients treated with direct‐acting antivirals after achieving a sustained virological response: A comprehensive analysis

“…Nineteen studies were identified assessing recurrence in high‐risk patients who achieved SVR following DAAs therapy 14,15,21,27‐29,45‐57 . The median follow‐up time post‐SVR was 17 months (interquartile range, 9‐21).…”

“…Nineteen studies were identified assessing recurrence in high-risk patients who achieved SVR following DAAs therapy. 14,15,21,[27][28][29][45][46][47][48][49][50][51][52][53][54][55][56][57] The median follow-up time post-SVR was 17 months (interquartile range, 9-21). Of those studies, four evaluated the risk in prisoners, 15,49,53,56 S2).…”

Evaluation of cure rate in patients with hepatitis C virus completing shortened courses of treatment

“…This study further supports the need for therapy optimization among patients who use drugs or who are in recovery. 15,16 Read et al 17 evaluated the effectiveness of adherence support in a highly marginalized patient population and found more than 95% cure rates in the enhanced adherence subpopulation. The patient population in this study was similar to that in our case series.…”

Integrated hepatitis C treatment is associated with improved retention and success in outpatient treatment for opioid use disorder at a private clinic

“…Non-clinical benefits for patients cured of HCV include improved quality of life and sense of wellbeing ( 30 ). Patients with OUD treated in the interferon era reported reduction in substance use-and return to “normality” as a result of curing their HCV ( 30 , 31 ).…”

“…Non-clinical benefits for patients cured of HCV include improved quality of life and sense of wellbeing ( 30 ). Patients with OUD treated in the interferon era reported reduction in substance use-and return to “normality” as a result of curing their HCV ( 30 , 31 ). Our analyses of patients with OUD who received integrated care with DAA in our clinic, builds on this literature, providing an objective assessment of measures of utilization of addiction care and indices of recovery.…”