title: Integrating services for injection drug users infected with hepatitis C virus with methadone maintenance treatment: challenges and opportunities.
abstract: Despite the high prevalence of hepatitis C virus (HCV) infection among drug users enrolled in methadone maintenance treatment programs, few drug users are being treated with combination therapy. The most significant barrier to treatment is lack of access to comprehensive HCV-related care. We describe a pilot program to integrate care for HCV infection with substance abuse treatment in a setting of maintenance treatment with methadone. This on-site, multidisciplinary model of care includes comprehensive screening and treatment for HCV infection, assessment of eligibility, counseling with regard to substance abuse, psychiatric services, HCV support groups, directly observed therapy, and enhanced linkages to a tertiary care system for diagnostic procedures. Our approach has led to high levels of adherence, with liver biopsy and substantial rates of initiation of antiviral therapy. Two cases illustrate the successful application of this model to patients with HCV infection complicated by active substance abuse and psychiatric comorbidity.
authors.affiliation: Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10455, USA. alitwin@montefiore.org
authors.forename: Alain H
authors.initials: AH
authors.lastname: Litwin
authors.forename: Irene
authors.initials: I
authors.lastname: Soloway
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated; D004608:Eligibility Determination / Q000592:standards; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009519:New York City; D010865:Pilot Projects; D012657:Self-Help Groups; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D008691:Methadone