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Developing a modified directly observed therapy intervention for hepatitis C treatment in a methadone maintenance program: implications for program replication.
- Source :
-
The American journal of drug and alcohol abuse [Am J Drug Alcohol Abuse] 2012 May; Vol. 38 (3), pp. 206-12. Date of Electronic Publication: 2012 Jan 13. - Publication Year :
- 2012
-
Abstract
- Background: Hepatitis C virus (HCV) is a prevalent chronic blood-borne infection among opioid-dependent patients on methadone maintenance treatment (MMT). Despite case reports and case-control studies, a randomized controlled trial (RCT) examining HCV treatment adherence in methadone-maintained patients is lacking and was the impetus for this ongoing RCT examining modified directly administered therapy for HCV treatment integrated within a MMT.<br />Methods: Subjects were randomized 1:1 to receive HCV treatment as modified directly observed therapy (mDOT) into the MMT program or at a liver specialty clinic as self-administered therapy (SAT). Randomization was stratified based on HIV status and HCV genotype.<br />Results: Twenty-one subjects to date have enrolled in this pilot study. The mDOT subjects have had greater success in starting treatment and 10 of the 12 mDOT subjects achieved early virologic response (EVR) at week 12 and 6 of those 10 achieved sustained virologic response (SVR). Of the nine SAT subjects, only three achieved EVR at week 12 and only one achieved SVR despite not completing the treatment.<br />Conclusions: Hepatitis C treatment can be successfully integrated into a methadone maintenance clinic, and mDOT can be implemented with a methadone clinic's existing nursing and medical staff. Patients struggling with concurrent substance use and mental illness comorbidity may be successfully addressed in such settings and facilitate access to and completion of treatment through the utilization of on-site clinical services for HCV treatment and adherence support with mDOT. The exact importance of site of services and adherence support remains a significant area for future investigation.
- Subjects :
- Adult
Antiviral Agents therapeutic use
Directly Observed Therapy psychology
Female
Hepacivirus drug effects
Hepatitis C complications
Hepatitis C virology
Humans
Male
Medication Adherence statistics & numerical data
Middle Aged
Opiate Substitution Treatment methods
Opioid-Related Disorders complications
Pilot Projects
Recombinant Proteins therapeutic use
Self Administration methods
Viral Load drug effects
Viral Load statistics & numerical data
Directly Observed Therapy methods
Hepatitis C drug therapy
Interferon-alpha therapeutic use
Methadone therapeutic use
Opiate Substitution Treatment psychology
Opioid-Related Disorders drug therapy
Polyethylene Glycols therapeutic use
Ribavirin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1097-9891
- Volume :
- 38
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The American journal of drug and alcohol abuse
- Publication Type :
- Academic Journal
- Accession number :
- 22242700
- Full Text :
- https://doi.org/10.3109/00952990.2011.643975