Prevalence and correlates of HCV infection among methadone maintenance attendees: implications for HCV treatment

Abstract

The HCV epidemic is thriving among often disadvantaged drug users. Current drug or alcohol use and underlying mental illness are contraindications for HCV treatment according to HCV treatment guidelines put forth by the U.S. National Institutes of Health. The authors determined the prevalence and the correlates of HCV infection among methadone maintenance treatment (MMT) participants in Baltimore, MD, USA and assessed the feasibility and public health importance of providing HCV treatment to drug users in this setting. Self-reported HCV infection and barriers to medical care were identified by an interviewer-administered survey. Individuals unaware of their HCV serostatus received an anti-HCV antibody EIA test. Correlates of HCV infection and barriers to HCV treatment were explored using logistic regression. To date, among 558 MMT participants, HCV prevalence was 64.7% and exceeded 90% among individuals reporting ever injecting drugs or sharing equipment. Factors independently associated with prevalent HCV infection included: increasing age (30–39 years: AOR: 0.82, 95% CI: 0.28, 2.42; 40–49 years: AOR: 3.42, 95% CI: 1.17, 9.99; 50+ years: AOR: 5.83, 95% CI: 1.70, 20.0); annual income of less than or equal to $5000 (AOR: 2.04, 95% CI: 1.23, 3.39); HIV infection (AOR: 2.11, 95% CI: 1.03, 4.36); prior HBV-infection, (AOR: 13.3, 95% CI: 6.53, 27.2); HBV immunisation (AOR: 3.60, 95% CI: 2.07, 6.27); years in MMT (AOR: 1.13, 95% CI: 1.03, 1.24); using drugs but not injecting in past month (AOR: 0.49 95% CI: 0.28, 0.87) and injecting drugs in past month (AOR: 6.5, 95% CI: 2.74, 15.4); and reporting a mental health problem (AOR: 2.86, 95% CI: 1.14, 7.20). Four barriers—lack of medical insurance, current alcohol or drug use and mental illness—would prevent 77% of the MMT participants from accessing HCV medical care and treatment according to criteria specified by NIH HCV treatment guidelines. MMT programmes represent an opportunity to counsel, screen, evaluate and provide ongoing HCV medical care and treatment.