Optimizing assessment and treatment for hepatitis C virus  infection in illicit drug users: a novel model incorporating  multidisciplinary care and peer support.
OBJECTIVE
We evaluated assessment and treatment for hepatitis C virus (HCV) among illicit drug users accepting referral to a weekly HCV peer-support group at a multidisciplinary community health centre.


METHODS
From March 2005 to 2008, HCV-infected individuals were referred to a weekly peer-support group and assessed for HCV infection. A retrospective chart review of outcomes 3 years after the initiation of the group was conducted (including HCV assessment and treatment).


RESULTS
Two hundred and four HCV antibody-positive illicit drug users accepted referral to a weekly HCV peer-support group. Assessment for HCV occurred in 53% of patients(n= 109), with 13% (n= 14) having initiated or completed treatment for HCV infection before attending the support group, evaluation ongoing in 10% (n= 11) and treatment deferred/not indicated in 25% (n= 27). The major reasons for HCV treatment deferral included early disease (30%),drug dependence (37%), other medical (11%) or psychiatric comorbidities (4%). Sixty-eight percent of those deferred for reasons other than early liver disease showed multiple reasons for treatment deferral. The first 4 weeks of support group attendance predicted successful HCV assessment (odds ratio: 6.03, 95% confidence interval:3.27-11.12, P < 0.001). Overall, 28% (n= 57) received treatment. Among individuals having completed pegylated-interferon and ribavirin therapy with appropriate follow-up (n =19), the rate of sustained virologic response was 63% (12/19), despite illicit drug use in 53%.


CONCLUSIONS
A high proportion of illicit drug users accepting referral to a weekly HCV peer-support group at a multidisciplinary health centre were assessed and treated for HCV infection. Peer support coupled with multidisciplinary care is an effective strategy for engaging illicit drug users in HCV care.
Grebely
Jason
J
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, New South Wales, Australia. jgrebely@nchecr.unsw.edu.au
Knight
Elizabeth
E
Genoway
Krista A
KA
Viljoen
Mark
M
Khara
Milan
M
Elliott
Doug
D
Gallagher
Lesley
L
Storms
Michelle
M
Raffa
Jesse D
JD
DeVlaming
Stanley
S
Duncan
Fiona
F
Conway
Brian
B
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004337:Drug Carriers; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D033183:Interdisciplinary Communication; D007372:Interferons / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016017:Odds Ratio; D010348:Patient Care Team; D010379:Peer Group; D011092:Polyethylene Glycols; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012657:Self-Help Groups; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
D000998:Antiviral Agents; D004337:Drug Carriers; D018937:Hepatitis C Antibodies; D011092:Polyethylene Glycols; D012254:Ribavirin; D007372:Interferons