Treatment of Chronic Hepatitis C Infection among Current And Former Injection Drug Users within a Multidisciplinary Treatment Model at a Community Health Centre

Abstract

The aim of the present prospective observational study was to assess uptake and success of hepatitis C virus (HCV) treatment among a group of former and current injection drug users with chronic HCV infection at the Street Health Centre in Kingston, Ontario. The Street Health Centre offers hepatitis C education, assessment and treatment within a multidisciplinary, integrated and collaborative treatment model of care delivered by primary care professionals. The study enrolled a convenience sample of 34 patients. Seventy per cent of study patients had no postsecondary education, 85% were unemployed and one-third were unstably housed. A majority of study patients self-reported mental health problems. Of the 14 patients who initiated antiviral treatment in the study period, eight (57%) achieved sustained virological response. Regardless of virological outcome, patients who initiated treatment showed positive trends toward increased social and psychiatric stability, and decreases in high-risk behaviours. These results suggest that not only is successful treatment of chronic HCV infection in current and former injection drug users with concurrent psychiatric disorders possible, but the benefits of such treatment delivered in a community-based, multidisciplinary, primary care model may extend beyond narrowly defined virological outcomes.

Evidence-based interventions to enhance assessment, treatment, and adherence in the chronic Hepatitis C care continuum

“…These studies demonstrated that patients with ongoing drug use and psychiatric comorbidity-- those traditionally excluded from systems of care-- can be effectively linked to care from and sometimes treated within these settings (Bruce et al, 2012; Jack, Willott, Manners, Varnam, & Thomson, 2009; McAllister et al, 2014; Morano et al, 2014; Newman et al, 2013; Seidenberg et al, 2013). One study implemented an integrated, multidisciplinary medical group visit to integrate care (Ho et al, 2013).…”

Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: The Australian Trial in Acute Hepatitis C

“…This is also particularly important given the potential risk for HCV reinfection following HCV treatment. Although the reported rates of HCV reinfection to date have been low (7, 40), continued risk reduction education will be important as interferon-free regimens are expanded to populations of PWID who might be at greater risk for re-exposure.…”

Can antiviral treatment for hepatitis C be safely and effectively delivered in primary care?

“…Again, British Journal of General Practice, December 2013 e847 Table 1 small numbers was a feature of the study, but further evidence of the potential for success was demonstrated. 18 The evidence would suggest that support needs to be offered to those who use drugs to engage with, and remain in, primary care-based treatment. Charlebois et al reported the effects of peer support in a multidisciplinary team in Toronto.…”