O211: Interactive case study: treatment of active drug users

Abstract

Although drug users (DUs) constitute the core of the hepatitis C epidemic with prevalence >70% documented in many studies, they have been one of the most challenging groups to treat due to a large number of obstacles. DUs frequently feel discomfort and may suffer discrimination in conventional healthcare settings, and a large preponderance is unlikely to travel when referred to offsite healthcare venues. Recent data has suggested that integrated treatment approaches that combine treatment for HCV and substance use together is likely to have improved efficacy compared to separate treatment approaches. A recent meta-analysis demonstrated that treatment efficacy using pegylated interferon and ribavirin in DUs is equivalent to that obtained in registration trials of non-DUs. Furthermore, provision of support services significantly increased treatment completion and the SVR rate was positively correlated with involvement of a multidisciplinary team (1). Major unanswered questions concern the optimal method of delivery of HCV care to DUs. In collaboration with the Centers for Disease Control (CDC), we are presently conducting Prevention, Evaluation and Treatment of Hepatitis C (PET-C), which is evaluating telemedicine as a vehicle for HCV management among patients in methadone maintenance.