Abstract
Background & aimsPeople 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 direct-acting 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.DesignThree prospective cohort studies of people who use illicit drugs.SettingVancouver, Canada.ParticipantsWe restricted the study sample to 1627 HCV-positive PWID between September 2005 and May 2015.MeasurementsA 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.FindingsIn 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.ConclusionsHCV-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.
Highlights
Hepatitis C virus (HCV) is a significant burden among people who inject drugs (PWID) globally, with prevalence estimates of approximately 60–80% [1]
HCV-positive PWID who enrolled in Methadone maintenance therapy (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
Summary
Hepatitis C virus (HCV) is a significant burden among people who inject drugs (PWID) globally, with prevalence estimates of approximately 60–80% [1]. Previous studies have shown that PWID are at greater risk of HCV infection and transmission due to a combination of individual factors and social-structural exposures, including high prevalence of poly-substance use, comorbidities, poor access to health care, socioeconomic marginalization, and the persistence of enforcement-based rather than health-based responses to illicit drug use [1,2,3,4]. Linkage to treatment and care are important considerations for addressing the HCV epidemic, as countries move towards universal coverage of direct-acting antiviral (DAA)-based therapy to treat HCV infection [7,8,9]. During the interferon-based treatment era, studies conducted in developed countries have shown that only 1–6% of this population have ever been treated, with fewer having been linked to care [10,11,12]. Given that many individuals living with HCV have underlying comorbid conditions and other socialstructural issues that may complicate care delivery, interventions that seek to improve the HCV care continuum should take into account a comprehensive and multidisciplinary approach to treatment and care [13,14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
