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      Under one roof: identification, evaluation, and treatment of chronic hepatitis C in addiction care

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          Abstract

          For over a decade, the vast majority of new hepatitis C virus (HCV) infections have been among young people who inject drugs (PWID). Well-characterized gaps in chronic HCV diagnosis, evaluation, and treatment have resulted in fewer than 5% of PWID receiving HCV treatment. While interferon-based treatment may have intentionally been foregone during part of this time in anticipation of improved oral therapies, the overall pattern points to deficiencies and treatment exclusions in the health care system. Treatment for HCV with all-oral, highly effective direct-acting antiviral medication for 12 weeks or less is now the standard of care, putting renewed focus on effective delivery of care. We describe here both the need for and process of chronic HCV care under the roof of addiction medicine.

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          Outcomes of treatment for hepatitis C virus infection by primary care providers.

          Sanjeev Arora, Karla Thornton, Glen H. Murata … (2011)
          The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases. We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response. A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, -9.2 to 10.7; P=0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites. The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.).
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            Chronic Hepatitis C Virus (HCV) Disease Burden and Cost in the United States

            Homie Razavi, Antoine ElKhoury, Elamin Elbasha … (2013)
            Hepatitis C virus (HCV) infection is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation. A better understanding of HCV disease progression and the associated cost can help the medical community manage HCV and develop treatment strategies in light of the emergence of several potent anti-HCV therapies. A system dynamic model with 36 cohorts was used to provide maximum flexibility and improved forecasting. New infections incidence of 16,020 (95% confidence interval, 13,510-19,510) was estimated in 2010. HCV viremic prevalence peaked in 1994 at 3.3 (2.8-4.0) million, but it is expected to decline by two-thirds by 2030. The prevalence of more advanced liver disease, however, is expected to increase, as well as the total cost associated with chronic HCV infection. Today, the total cost is estimated at $6.5 ($4.3-$8.4) billion and it will peak in 2024 at $9.1 ($6.4-$13.3) billion. The lifetime cost of an individual infected with HCV in 2011 was estimated at $64,490. However, this cost is significantly higher among individuals with a longer life expectancy. Conclusion This analysis demonstrates that US HCV prevalence is in decline due to a lower incidence of infections. However, the prevalence of advanced liver disease will continue to increase as well as the corresponding healthcare costs. Lifetime healthcare costs for an HCV-infected person are significantly higher than for noninfected persons. In addition, it is possible to substantially reduce HCV infection through active management.
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              Assessment and treatment of hepatitis C virus infection among people who inject drugs in the opioid substitution setting: ETHOS study.

              Alexander Day, Michelle Micallef, Jason Grebely … (2013)
              Access to hepatitis C virus (HCV) treatment remains extremely limited among people who inject drugs (PWID). HCV assessment and treatment was evaluated through an innovative model for the provision of HCV care among PWID with chronic HCV infection. Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) was a prospective observational cohort. Recruitment was through 5 opioid substitution treatment (OST) clinics, 2 community health centers, and 1 Aboriginal community controlled health organization in New South Wales, Australia. Among 387 enrolled participants, mean age was 41 years, 71% were male, and 15% were of Aboriginal ethnicity. Specialist assessment was undertaken in 191 (49%) participants, and 84 (22%) commenced interferon-based treatment. In adjusted analysis, HCV specialist assessment was associated with non-Aboriginal ethnicity (adjusted odds ratio [AOR], 4.02; 95% confidence interval [CI], 2.05-7.90), no recent benzodiazepine use (AOR, 2.06; 95% CI, 1.31-3.24), and non-1 HCV genotype (AOR, 2.13; 95% CI, 1.32-3.43). In adjusted analysis, HCV treatment was associated with non-Aboriginal ethnicity (AOR, 4.59; 95% CI, 1.49-14.12), living with the support of family and/or friends (AOR, 2.15; 95% CI, 1.25-3.71), never receiving OST (AOR, 4.40; 95% CI, 2.27-8.54), no recent methamphetamine use (AOR, 2.26; 95% CI, 1.12-4.57), and non-1 HCV genotype (AOR, 3.07; 95% CI, 1.67-5.64). HCV treatment uptake was relatively high among this highly marginalized population of PWID. Potentially modifiable factors associated with treatment include drug use and social support.
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                Author and article information

                Contributors
                Stephen A. Martin: stmartin@gmail.com
                Jordon Bosse: jbosse@nursing.umass.edu
                Amanda Wilson: awilson@cleanslatecenters.com
                Phyllis Losikoff: PLosikoff@cleanslatecenters.com
                Lisa Chiodo: lisachiodo@nursing.umass.edu
                Journal
                Journal ID (nlm-ta): Addict Sci Clin Pract
                Journal ID (iso-abbrev): Addict Sci Clin Pract
                Title: Addiction Science & Clinical Practice
                Publisher: BioMed Central (London )
                ISSN (Print): 1940-0632
                ISSN (Electronic): 1940-0640
                Publication date (Electronic): 25 April 2018
                Publication date PMC-release: 25 April 2018
                Publication date (Print): 2018
                Volume: 13
                Electronic Location Identifier: 10
                Affiliations
                [1 ]ISNI 0000 0001 0742 0364, GRID grid.168645.8, Department of Family Medicine and Community Health, , University of Massachusetts Medical School, ; 55 Lake Avenue North, Worcester, MA 01655 USA
                [2 ]Barre Family Health Center, 151 Worcester Road, Barre, MA 01005 USA
                [3 ]CleanSlate Research and Education Foundation, 1 Roundhouse Plaza, Northampton, MA 01060 USA
                [4 ]ISNI 0000 0001 2184 9220, GRID grid.266683.f, University of Massachusetts College of Nursing, ; 651 North Pleasant Street, Amherst, MA 01003 USA
                [5 ]ISNI 0000 0004 1936 9094, GRID grid.40263.33, Division of Pediatric Infectious Disease, , The Warren Alpert Medical School of Brown University, ; Box G-A1, Providence, RI 02912 USA
                [6 ]CleanSlate Centers, 92 Grape Street, New Bedford, MA 02740 USA
                Article
                Publisher ID: 111
                DOI: 10.1186/s13722-018-0111-7
                PMC ID: 5937807
                PubMed ID: 29690936
                SO-VID: 568896c7-6abd-49b2-9910-93f987b1217b
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 20 July 2017
                Date accepted : 14 February 2018
                Funding
                Funded by: CleanSlate Research and Education Foundation
                Categories
                Subject: Commentary
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Health & Social care
                Keywords: opioid use disorder,chronic hepatitis c,cirrhosis,hepatitis c epidemiology,hepatitis c treatment,treatment cascade,project echo,continuity of care
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: opioid use disorder, chronic hepatitis c, cirrhosis, hepatitis c epidemiology, hepatitis c treatment, treatment cascade, project echo, continuity of care

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