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      Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia

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          Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all.

          Philip Bruggmann, Alain H. Litwin (2013)
          One of the major obstacles to hepatitis C virus (HCV) care in people who inject drugs (PWID) is the lack of treatment settings that are suitably adapted for the needs of this vulnerable population. Nevertheless, HCV treatment has been delivered successfully to PWID through various multidisciplinary models such as community-based clinics, substance abuse treatment clinics, and specialized hospital-based clinics. Models may be integrated in primary care--all under one roof in either addiction care units or general practitioner-based models--or can occur in secondary or tertiary care settings. Additional innovative models include directly observed therapy and peer-based models. A high level of acceptance of the individual life circumstances of PWID rather than rigid exclusion criteria will determine the level of success of any model of HCV management. The impact of highly potent and well-tolerated interferon-free HCV treatment regimens will remain negligible as long as access to therapy cannot be expanded to the most affected risk groups.
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            Methadone as social control: institutionalized stigma and the prospect of recovery.

            Julie Harris, Karen McElrath (2012)
            Methadone maintenance treatment (MMT) is an intervention used to treat opioid (heroin) dependence. Several investigators have found that MMT is effective in reducing heroin use and other behaviors; however, a disproportionate number of MMT clients leave treatment prematurely. Moreover, MMT outcome variables are often limited in terms of their measurement. Utilizing an integrated theoretical framework of social control and stigma, we focused on the experiences of methadone maintenance from the perspective of clients. We pooled interview data from four qualitative studies in two jurisdictions and found linkages between social control and institutional stigma that serve to reinforce "addict" identities, expose undeserving customers to the public gaze, and encourage clients to be passive recipients of treatment. We discuss the implications for recovery and suggest recommendations for change.
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              Barriers to the treatment of hepatitis C. Patient, provider, and system factors.

              George W. Grant, M Shrestha, Haley J Morrill (2005)
              Hepatitis C virus (HCV) infection is both prevalent and undertreated. To identify barriers to HCV treatment in primary care practice. Cross-sectional study. A cohort of 208 HCV-infected patients under the care of a primary care physician (PCP) between December 2001 and April 2004 at a single academically affiliated community health center. Data were collected from the electronic medical record (EMR), the hospital clinical data repository, and interviews with PCPs. Our cohort consisted of 208 viremic patients with HCV infection. The mean age was 47.6 (+/-9.7) years, 56% were male, and 79% were white. Fifty-seven patients (27.4% of the cohort) had undergone HCV treatment. Independent predictors of not being treated included: unmarried status (adjusted odds ratio [aOR] for treatment 0.36, P=.02), female gender (aOR 0.31, P=.01), current alcohol abuse (aOR 0.08, P=.0008), and a higher ratio of no-shows to total visits (aOR 0.005 per change of 1.0 in the ratio of no-shows to total visits, P=.002). The major PCP-identified reasons not to treat included: substance abuse (22.5%), patient preference (16%), psychiatric comorbidity (15%), and a delay in specialist input (12%). For 13% of the untreated patients, no reason was identified. HCV treatment was infrequent in our cohort of outpatients. Barriers to treatment included patient factors (patient preference, alcohol use, missed appointments), provider factors (reluctance to treat past substance abusers), and system factors (referral-associated delays). Multimodal interventions may be required to increase HCV treatment rates.
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                Author and article information

                Journal
                Title: International Journal of Drug Policy
                Abbreviated Title: International Journal of Drug Policy
                Publisher: Elsevier BV
                ISSN (Print): 09553959
                Publication date Created: October 2015
                Publication date (Print): October 2015
                Volume: 26
                Issue: 10
                Pages: 992-998
                Article
                DOI: 10.1016/j.drugpo.2015.01.005
                PubMed ID: 25697089
                SO-VID: 6824fa73-d6ba-4036-b07e-9b4d6968d857
                Copyright © © 2015
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