Hepatitis C Virus Treatment Status and Barriers among Patients in Methadone Maintenance Treatment Clinics in Guangdong Province, China: A Cross-Sectional, Observational Study.

Yin Liu,Wen Chen,Xia Zou,Li Ling,Cheng Gong

doi:10.3390/ijerph16224436

Abstract

We aimed to evaluate the status and barriers related to hepatitis C virus (HCV) treatment among Chinese methadone maintenance treatment (MMT) clients, and the willingness and barriers of patients to accept directly observed treatment (DOT) service and oral direct-acting antivirals (DAAs). We conducted a cross-sectional survey from July to October 2017 in Guangdong Province, China, involving 678 HCV antibody-positive MMT patients. If they reported being infected with HCV, then their HCV treatment experience, willingness to use DOT and DAAs, along with any barriers, were collected. Logistic regression analysis was used to identify the correlates of initiating HCV treatment. Among those reporting HCV infection (54%, 366/678), 39% (144/366) initiated treatment; however, 38% (55/144) interrupted and 55% (79/135) delayed treatment for 15 months. Seventy-five percent (273/366) and 53% (195/366) were willing to use DOT and DAAs, respectively. Unaffordable medical costs and insignificant symptoms were the major barriers to HCV treatment and accepting DOT or DAAs. The lack of a stable residence, being a woman, and having ever injected drugs were all associated with a low probability of initiating treatment (p < 0.05). This study highlights a limited uptake of HCV treatment among MMT patients, and a need to strengthen the popularity of DOT and DAAs and integrate them into Chinese MMT clinics.

Highlights

Hepatitis C virus (HCV) infection is associated with an excess risk of chronic hepatitis, cirrhosis, hepatocellular carcinoma, and liver transplantation [1]
Patient Characteristics According to Self-Reported HCV Status
A total of 858 clients were interviewed, after excluding those whose HCV antibody tests had been negative within six months according to the testing records at the maintenance treatment (MMT) clinics, 678 HCV

Summary

Introduction

Hepatitis C virus (HCV) infection is associated with an excess risk of chronic hepatitis, cirrhosis, hepatocellular carcinoma, and liver transplantation [1]. People who use drugs (PWUD), especially people who inject drugs (PWID), are the primary high-risk population for HCV infection [2]. Approximately 52% of PWID are HCV antibody positive [3]. In 2017, 2.553 million PWUD were registered in China [4], and a national report suggested that up to 33.4% of PWUD and 61.2% of PWID were HCV antibody positive [5]. The World Health Organization (WHO) put forward a 2030 target for the elimination of viral hepatitis and the provision of treatment for 80% of diagnosed HCV cases [6]. The methadone maintenance treatment (MMT) program, a community-based opioid substitution therapy, provides a good opportunity to deliver interventions or medical services for HCV-infected

Objectives

Methods

Results

Discussion

Conclusion