title: A novel program for treating patients with trimorbidity: hepatitis C, serious mental illness, and active substance use.
abstract: BACKGROUND
  Advances in hepatitis C virus (HCV) treatment have yielded improved virological response rates, and yet, many individuals with psychiatric illness still fail to receive HCV therapy. Concerns about safety, adherence, and efficacy of HCV treatment are compounded and treatment is further deferred when substance use is also present. This is especially problematic given the disproportionately high rates of both mental health issues and substance use among individuals living with HCV.
  
  
  OBJECTIVE
  This study sought to examine HCV treatment outcomes in clients with serious mental illness (SMI) and with high rates of active substance use who were participating in a community-based HCV treatment program.
  
  
  METHODS
  A retrospective chart review of 129 clients was carried out. Patients were classified as having an SMI if they had a history of bipolar disorder, psychotic disorder, past suicide attempt or mental health related hospitalization.
  
  
  RESULTS
  Fifty-one patients were defined as having an SMI. Among the 46 patients with SMI and a detectable HCV viral load, HCV antiviral therapy was initiated in nine (19.6%). A relapse or an increase in substance use was common (77.8% or n=7), as was the requirement for adjustment or initiation of psychotropic medications (66.7% or n=6) during HCV antiviral therapy. Despite these barriers, rates of adherence to antiviral therapy were high and overall sustained virological response rates were comparable with published trials.
  
  
  CONCLUSIONS
  This study is the first to report HCV treatment outcomes in a population in which SMI and active polysubstance use was prevalent and suggests that with appropriate models of care, clients with trimorbidity can be treated safely and effectively.
authors.affiliation: aMedical Psychiatry Program, University Health Network, Toronto General Hospital Departments of bPsychiatry cPsychology dMedicine, University of Toronto eSouth Riverdale Community Health Centre fToronto East General Hospital, Toronto, Ontario, Canada.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.forename: Diana
authors.initials: D
authors.lastname: Blank
authors.forename: Claire Ann
authors.initials: CA
authors.lastname: Banga
authors.forename: Kate
authors.initials: K
authors.lastname: Mason
authors.forename: Zoë
authors.initials: Z
authors.lastname: Dodd
authors.forename: Jeff
authors.initials: J
authors.lastname: Powis
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents