title: Retention in buprenorphine treatment is associated with improved HCV care outcomes.
abstract: Persons who inject drugs, most of whom are opioid dependent, comprise the majority of the HCV infected in the United States. As the national opioid epidemic unfolds, increasing numbers of people are entering the medical system to access treatment for opioid use disorder, specifically with buprenorphine. Yet little is known about HCV care in patients accessing buprenorphine-based opioid treatment. We sought to determine the HCV prevalence, cascade of care, and the association between patient characteristics and completion of HCV cascade of care milestones for patients initiating buprenorphine treatment. We reviewed electronic health records of all patients who initiated buprenorphine treatment at a primary-care clinic in the Bronx, NY between January 2009 and January 2014. Of the 390 patients who initiated buprenorphine treatment, 123 were confirmed to have chronic HCV infection. The only patient characteristic associated with achieving HCV care milestones was retention in opioid treatment. Patients retained (vs. not retained) in buprenorphine treatment were more likely to be referred for HCV specialty care (63.1% vs. 34.0%, p<0.01), achieve an HCV-specific evaluation (40.8% vs. 21.3%, p<0.05), be offered HCV treatment (22.4% vs. 8.5%, p<0.05), and initiate HCV treatment (9.2% vs. 6.4%, p=0.6). Given the current opioid epidemic in the US and the growing number of people receiving buprenorphine treatment, there is an unprecedented opportunity to access and treat persons with HCV, reducing HCV transmission, morbidity and mortality. Retention in opioid treatment may improve linkage and retention in HCV care; innovative models of care that integrate opioid drug treatment with HCV treatment are essential.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States. Electronic address: bnorton@montefiore.org.
authors.forename: B L
authors.initials: BL
authors.lastname: Norton
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
authors.forename: A
authors.initials: A
authors.lastname: Beitin
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
authors.forename: M
authors.initials: M
authors.lastname: Glenn
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
authors.forename: J
authors.initials: J
authors.lastname: DeLuca
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
authors.forename: A H
authors.initials: AH
authors.lastname: Litwin
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
authors.forename: C O
authors.initials: CO
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D010349:Patient Compliance; D016896:Treatment Outcome
chemical_list: D006508:Hepatitis Antibodies; D002047:Buprenorphine
keywords: Buprenorphine; Cascade of care; Hepatitis C; Medication assisted treatment; Opioid use disorder