Integrated care for methadone maintenance patients with hepatitis C virus infection

Kaohsiung Journal of Medical Sciences

卷:35

Chi‐Ming Tai¹  Cheng‐Hao Tseng¹  Ting‐Ting Chang²  Ming‐Jong Bair³  Ming‐Lun Yeh⁴  Wan‐Long Chuang⁴  Jee‐Fu Huang⁴  Chung‐Feng Huang⁴  Chia‐Yen Dai⁴  Ming‐Lung Yu⁴  Yung‐Chieh Yen⁵ 

[1] Department of Internal Medicine E‐Da Hospital Kaohsiung Taiwan;

[2] Department of Psychiatry E‐Da Hospital, I‐Shou University Kaohsiung Taiwan;

[3] Division of Gastroenterology, Department of Internal Medicine Taitung Mackay Memorial Hospital Taiwan;

[4] Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center Kaohsiung Medical University Hospital Kaohsiung Taiwan;

[5] School of Medicine College of Medicine, I‐Shou University Kaohsiung Taiwan;

关键词: hepatitis C virus;    methadone maintenance treatment;    people who inject drugs;    substance abuse;   

DOI  :  10.1002/kjm2.12086

来源: DOAJ

【 摘 要 】

Abstract The majority of patients undergoing methadone maintenance treatment (MMT) are neither examined nor treated for hepatitis C virus (HCV) infection. We aimed to evaluate an integrated referral model in the management of HCV among MMT patients. This retrospective study included 390 HCV‐infected MMT patients between April 2015 and May 2017. Patients who tested positive for HCV antibodies were referred to a liver clinic by MMT case managers or psychiatrists. Patients who agreed to receive anti‐HCV treatment were treated with pegylated interferon and ribavirin. The rate of patient engagement at a liver clinic increased from 14.1% to 58.2% after integrated care. Multiple logistic regression analysis showed that higher education level (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.01‐2.60) and elevated ALT level (OR, 4.30; 95% CI, 2.70‐6.85) were independently associated with patients who accepted referral. Active drug use (OR, 0.52; 95% CI, 0.31‐0.85) was inversely associated with referral acceptance. Of the 112 patients who met the criteria for anti‐HCV therapy, 66 (58.9%) were treated with pegylated interferon and ribavirin. Finally, the rate of treatment completion and sustained virological response (SVR) was 65.2% and 54.5%, respectively, among the 66 patients. Treatment completion (OR, 39.67; 95% CI, 7.80‐201.62) was found to be the only independent factor associated with SVR achievement. Although integrated care by psychiatrists and hepatologists significantly increased the rates of engagement and acceptance of antiviral treatment for HCV‐infected MMT patients, only a minority of MMT patients achieved successful treatment.

【 授权许可】

Unknown