title: Assessment and treatment of hepatitis C virus infection among people who inject drugs in the opioid substitution setting: ETHOS study.
abstract: BACKGROUND
  Access to hepatitis C virus (HCV) treatment remains extremely limited among people who inject drugs (PWID). HCV assessment and treatment was evaluated through an innovative model for the provision of HCV care among PWID with chronic HCV infection.
  
  
  METHODS
  Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) was a prospective observational cohort. Recruitment was through 5 opioid substitution treatment (OST) clinics, 2 community health centers, and 1 Aboriginal community controlled health organization in New South Wales, Australia.
  
  
  RESULTS
  Among 387 enrolled participants, mean age was 41 years, 71% were male, and 15% were of Aboriginal ethnicity. Specialist assessment was undertaken in 191 (49%) participants, and 84 (22%) commenced interferon-based treatment. In adjusted analysis, HCV specialist assessment was associated with non-Aboriginal ethnicity (adjusted odds ratio [AOR], 4.02; 95% confidence interval [CI], 2.05-7.90), no recent benzodiazepine use (AOR, 2.06; 95% CI, 1.31-3.24), and non-1 HCV genotype (AOR, 2.13; 95% CI, 1.32-3.43). In adjusted analysis, HCV treatment was associated with non-Aboriginal ethnicity (AOR, 4.59; 95% CI, 1.49-14.12), living with the support of family and/or friends (AOR, 2.15; 95% CI, 1.25-3.71), never receiving OST (AOR, 4.40; 95% CI, 2.27-8.54), no recent methamphetamine use (AOR, 2.26; 95% CI, 1.12-4.57), and non-1 HCV genotype (AOR, 3.07; 95% CI, 1.67-5.64).
  
  
  CONCLUSIONS
  HCV treatment uptake was relatively high among this highly marginalized population of PWID. Potentially modifiable factors associated with treatment include drug use and social support.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia. msalehialavi@kirby.unsw.edu.au
authors.forename: Maryam
authors.initials: M
authors.lastname: Alavi
authors.forename: Jason
authors.initials: J
authors.lastname: Grebely
authors.forename: Michelle
authors.initials: M
authors.lastname: Micallef
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Dunlop
authors.forename: Annie C
authors.initials: AC
authors.lastname: Balcomb
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Day
authors.forename: Carla
authors.initials: C
authors.lastname: Treloar
authors.forename: Nicky
authors.initials: N
authors.lastname: Bath
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dore
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D058850:Opiate Substitution Treatment; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: HCV; PWID; drug users; integrated care; opioid substitution