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Heroin Addiction and Related Clinical Problems: 2017, 19, N3 (pages: 11 - 20)

Enhancing Knowledge and Reducing Barriers Improve Hepatitis C Management in Methadone Maintenance Treatment Patients

Peles E., Adelson M., Sason A., Katchman H., Bruck R., Levit S., Schreiber S., and Shibolet O.

Summary: Background: Lack of knowledge and bureaucratic obstacles may prevent hepatitis C virus (HCV) treatment among methadone maintenance treatment (MMT) patients. Aims: to improve knowledge and enhance HCV treatment. Methods: HCV seropositive patients were invited to attend a lecture on HCV disease. Participants completed Virus-knowledge and Depression questionnaires before and after the lecture, and were then referred to evaluation and treatment in Liver Unit. Results: Of all the 80 eligible patients invited, 48 attended the lecture and scored significantly better on knowledge about HCV than the non-attendees. Having attended a lecture predicted referral to treatment (Odds ratio (OR) = 13 (95% Confidence Interval (CI) I 3.9-44.9 P < 0.0005)). Of the 41 referrals, only 21(51.2%) actually presented at the Liver Unit; they were characterized by lower depression scores (OR=0.2, 95%CI 0.06-0.9 P = 0.03). Despite administrative barriers, 15 (71.4%) underwent evaluation, 12 (80%) initiated anti-HCV treatment with pegylated interferon, ribavirin with (G1) or without (G2 and G3), a first generation protease inhibitor. Nine patients (75%) achieved sustained virologic response (one was a non-responder and two stopped treatment due to adverse events). Of the 59 who were referred, but did not arrive at the Liver Unit, 14 (23.7%) were followed up elsewhere, but only one of them (7.1%) started treatment. Conclusions: The fact of attending a single lecture led to improved knowledge and enhanced HCV treatment initiation among MMT patients, although the attendees and non-attendees alike still continued to show a certain degree of depression. Interventions to reduce administrative barriers and improve patients' knowledge about HCV disease, together with treatment of depression when needed, are recommended in MMT patients infected with HCV.