The impact of methadone maintenance therapy on access to regular physician care regarding hepatitis C among people who inject drugs

Abstract

Background & aims: People who inject drugs (PWID) living with hepatitis C virus (HCV) infection often experience barriers to accessing HCV treatment and care. New, safer and more effective directacting antiviral-based therapies offer an opportunity to scale-up HCV-related services. Methadone maintenance therapy (MMT) programs have been shown to be effective in linking PWID to health and support services, largely in the context of HIV. The objective of the study was to examine the relationship between being enrolled in MMT and having access to regular physician care regarding HCV among HCV antibody-positive PWID in Vancouver, Canada. Design: Three prospective cohort studies of people who use illicit drugs. Setting: Vancouver, Canada. Participants: We restricted the study sample to 1627 HCV-positive PWID between September 2005 and May 2015. Measurements: A marginal structural model using inverse probability of treatment weights was used to estimate the longitudinal relationship between being enrolled in MMT and having a regular HCV physician and/or specialist. Findings: In total, 1357 (83.4%) reported having access to regular physician care regarding HCV at least once during the study period. A marginal structural model estimated a 2.12 (95% confidence interval [CI]: 1.77-2.20) greater odds of having a regular HCV physician among participants enrolled in MMT compared to those not enrolled. Conclusions: HCV-positive PWID who enrolled in MMT were more likely to report access to regular physician care regarding HCV compared to those not enrolled in MMT. These findings demonstrate that opioid agonist treatment may be helpful in linking PWID to HCV care, and highlight the need to better engage people who use drugs in substance use care, when appropriate.