Greater HCV Treatment Needed in Care for People Who Inject Drugs

Lianping Ti, PhD, of St. Paul Hospital

Lianping Ti, PhD

People who inject drugs (PWID) are at a heightened risk for contracting hepatitis C (HCV), yet few treatment programs for the viral infection are integrated into addiction care. Despite the benefits of integrating HCV treatment into the care of PWID, several challenges exist in health care that must be overcome in order implement this approach in clinical practice, according to a viewpoint article in the International Journal of Drug Policy.

There is currently a substantial need to develop and implement community-based, low-threshold HCV testing as well as treatment services within existing addiction treatment programs, the study’s researcher Lianping Ti, PhD, of St. Paul’s Hospital in Vancouver, Canada, told MD Mag.

“In the context of HIV, integrating HIV services within opioid agonist treatment programs has shown to be successful in engaging and retaining people who inject drugs in follow-up care,” Ti added. “In the era of direct-acting antiviral (DAA) based therapy where treatment is shorter, safer and more tolerable than previous therapies, there is an opportunity to redesign addiction programs to address HCV with consideration for the overall health of people who inject drugs to prevent HCV infection and reinfection.”

The risk of HCV is disproportionally higher in PWID, yet the uptake of treatment for the viral infection is lower in this subset of the population. Even following the introduction of new Direct Acting Antiviral (DAA) drugs, PWID still lack appropriate access to much-needed antiviral therapy. A lack of treatment approaches further increases the risk of end-stage liver disease as well as further transmission and places a higher burden on the health care system at large.

According to the researchers, the use of onsite and integrated community-based addiction therapies may improve access to HCV care. Additionally, these integrated care models may improve clinicians’ understanding of this population’s unique needs, ultimately assisting in developing tailored treatment approaches that increase the uptake of HCV treatment.

The researchers also argue that the integration of DAA-based therapies into existing community-based addiction care models will be easier to perform than with interferon-based treatments and may also result in better patient compliance.

Currently, there exists several challenges that need to be addressed prior to the implementation of integrated care programs for individuals who inject drugs, according to Ti.

“In my opinion, given the increase in stimulant use among people who inject drugs, future research should focus on the development of pharmacological and non-pharmacological treatment options for stimulant use disorder,” Ti said. “We already know that successful HCV treatment and care outcomes has been shown among people on opioid agonist therapy. Additionally, given universal access of DAA-based medications in some settings, an evaluation of willingness to treat and care for patients living with HCV among addiction medicine physicians and non-specialists could be another area that could be further explored in future research.”

In addition, considering the reinfection risks among individuals who inject drugs, additional research studies may be required to elucidate the impact of harm reduction, in addition to other support services, on reinfection. Ti notes that the “BC Centre for Excellence in HIV/AIDS is currently conducting a study looking at factors that protect against reinfection among PWID as well as other key populations.”

REFERENCE:

Bird K, Socías ME, Ti L. Integrating hepatitis C and addiction care for people who inject drugs in the era of direct-acting antiviral therapy. Int J Drug Policy. 2018;59:1-2. doi: 10.1016/j.drugpo.2018.06.002.