title: Psychoeducation improves hepatitis C virus treatment during opioid substitution therapy: a controlled, prospective multicenter trial.
abstract: BACKGROUND
  People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV) infection. However, PWID are considered "difficult to treat," requiring a specifically adapted treatment setting, including psychosocial support.
  
  
  METHODS
  In this prospective, German trial, the impact of psychoeducation (PE) on retention and sustained virologic response (SVR) during HCV therapy among PWID was evaluated. We included 198 patients in opiate substitution therapy, who fulfilled indications for antiviral treatment. All patients received pegylated interferon alfa-2a and ribavirin therapy. Patients in the intervention group (n = 82) received manualized PE sessions.
  
  
  RESULTS
  In patients with HCV genotype 1 or 4 (GT 1/4), PE was associated with increased treatment completion (76% vs 55%, P = .038), whereas PE had no such effect among GT 2/3 patients, who showed fewer dropouts and higher SVR rates. Among GT 1/4 patients, a minimum of 5 PE sessions was associated with increased SVR (71% vs 48%, P = .037). Multivariate regression analyses confirmed the impact of PE in GT 1/4 and revealed further predictors for retention and SVR, such as preexisting mental distress and adverse events.
  
  
  CONCLUSIONS
  In patients with a higher risk of dropout due to GT 1/4 or mental distress, PE was shown to improve retention and SVR. PE is an effective supportive intervention for HCV therapy among PWID.
authors.affiliation: Centre for Interdisciplinary Addiction Research, CIAR, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. reimer@uke.de
authors.forename: Jens
authors.initials: J
authors.lastname: Reimer
authors.forename: Christiane Sybille
authors.initials: CS
authors.lastname: Schmidt
authors.forename: Bernd
authors.initials: B
authors.lastname: Schulte
authors.forename: Dirk
authors.initials: D
authors.lastname: Gansefort
authors.forename: Jörg
authors.initials: J
authors.lastname: Gölz
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Norbert
authors.initials: N
authors.lastname: Scherbaum
authors.forename: Uwe
authors.initials: U
authors.lastname: Verthein
authors.forename: Markus
authors.initials: M
authors.lastname: Backmund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005858:Germany; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D012254:Ribavirin / Q000008:administration & dosage; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: antiviral treatment; hepatitis C; injection drug users; psychoeducation; retention