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Successful Integration of Hepatitis C Evaluation and Treatment Services With Methadone Maintenance

Harris, Kenneth A. Jr MD, PhD; Arnsten, Julia H. MD, MPH; Litwin, Alain H. MD, MPH, MS

Journal of Addiction Medicine: March 2010 - Volume 4 - Issue 1 - p 20-26
doi: 10.1097/ADM.0b013e3181add3de
Original Article

Objectives: Despite high rates of hepatitis C virus (HCV) infection, relatively few current or former injection drug users receive evaluation and treatment for HCV. Here, we demonstrate the feasibility and effectiveness of integrating HCV care and methadone maintenance treatment (MMT). We hypothesized that colocation of these services would result in improved access to and utilization of HCV care.

Methods: In this retrospective observational study, all patient charts from a single MMT clinic were reviewed 2 years after HCV care and MMT were integrated. Information obtained included screening for and counseling about HCV infection status, on-site HCV treatment and outcomes, and demographic and substance abuse data.

Results: Two hundred ninety-one patient charts were reviewed. Two hundred eighty-one (99%) patients were screened for HCV antibody (HCV-Ab), and 188 (65%) were positive. Forty-nine (17%) patients were HIV/HCV coinfected. Ninety-eight percent of the HCV-Ab-positive patients received HCV counseling. Hundred fifty-nine (85%) of the HCV-Ab-positive patients were eligible to receive further evaluation and treatment for HCV on site, and 125 (78%) accepted. Hundred eighteen (94%) patients were tested for chronic HCV, and 83 were determined to have chronic HCV. Twenty-five patients received liver biopsy; low-stage disease was found in 7 patients. Twenty-one patients initiated HCV treatment. Sustained viral response was achieved in 8 patients. Seventeen patients had contraindications to HCV treatment. Further workup was prevented or delayed in 45 patients for various reasons, most commonly due to personal choice (29 patients).

Conclusions: This study demonstrates that current and former injection drug users can be engaged successfully in evaluation and treatment of HCV infection when these services are collocated with MMT.

From the Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences (KAH, AHL) and Division of General Internal Medicine, Department of Medicine (KAH, JHA, AHL), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.

Received for publication October 28, 2008; accepted May 11, 2009.

Supported by NIH Grant R25 DA 14551 and Center for AIDS Research Grant P30 A151519 (awarded to the Albert Einstein College of Medicine of Yeshiva University), New York State Office of Alcoholism and Substance Abuse Services Grant C-002464 (Division of Substance Abuse), New York State Department of Health AIDS Institute (HIV primary care program), and Centers for Disease Control and Prevention Grant CDC U50 CCU22419201 (HCV support groups).

Send correspondence and reprint requests to Kenneth A. Harris, Jr., MD, PhD, Division of Substance Abuse, Albert Einstein College of Medicine, 1510 Waters Place, Bronx, NY 10461. e-mail:

© 2010 American Society of Addiction Medicine