4099.0: Tuesday, November 14, 2000 - Board 1

Abstract #8674

Hepatitis C virus (HCV) antibody testing, follow-up, and clinical management among in treatment drug users: A preliminary report from a San Francisco methadone maintenance (MMT) program

M. Patricia Perkins, MS, Research Administration, BAART/CDP & M&Z Group, 536 Green Street, San Francisco, CA 94133, 888-990-2343, perkynomads@hotmail.com, Laurene Spencer, MD, Geary Street Clinic, BAART/CDP, 1040 Geary Street, San Francisco, CA 94109, Audrey Sellers, MD, Market Street Clinic, BAART/CDP, 1111 Market Street, San Francisco, CA 94103, Layla Alpers, MS, Dept. of Family and Community Medicine: San Francisco Gen'l Hospital, University of California at San Francisco, William Shore, MD, Dept. of Family and Community Medicine, University of California at San Francisco, SF Gen'l Hospital, Adil Ed Wakil, MD, Gastroenterology/Liver Transplant Team, California Pacific Medical Center, San Francisco, CA, Don Des Jarlais, PhD, Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, and Allen Frank, MD, Medical Director/Division of Medical Affairs, Home Access Health, Hoffman Estates, IL.

HIV antibody screening programs within drug treatment settings are well documented in the literature. Despite presumed high rates of hepatitis C virus (HCV) positivity among persons with injection drug use (IDU) histories, few published reports are available on the implementation or results of targeted HCV screening and treatment delivery to in- or out-of-treatment drug users (DUs). Improvements in clinical management of HCV disease may argue for more targeted screening efforts with high risk persons, particularly within drug treatment settings. We report on our experience with HCV screening at the largest MMT system in San Francisco; HCV prevalence within this setting, success in patient call-back to obtain test results; referral for follow-up to community clinics or an area gastroenterologist; and preliminary data on patient acceptance and success on HCV combination therapy. 300 patients were screened for HCV, representing an HCV positive prevalence of 74.6%. Factors predictive of an HCV negative result included: age (under 25); female gender, non-injection use of illicit drugs; and lower number of years of injection history. Of those tested, 36% received their results within 30 days; the remaining patients required more targeted intervention. Lack of medical insurance or concurrent positive HIV status resulted in referral for 35% of the HCV+ cases. The remainder were offered clinical evaluation within our setting. Demographic, risk profile, and other factors predictive of receiving HCV test results within 30 days will be explored, as will factors predictive of obtaining follow-up within the community within 90 days of referral.

Learning Objectives: 1. Describe targeted and enhanced hepatitis C screening, referral, and follow-up program within a drug treatment setting. 2. Discuss impediments to MMT patients' engagement in hepatitis C follow-up services. 3. Analyze role of short-term medical student preceptor students versus long-term drug treatment counselors success in engaging hepatitis C methadone patients in care-delivery

Keywords: Methadone Maintenance, Hepatitis C

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Home Access Health, Hoffman Estates, IL Schering Oncology Biotech, Schering Plough
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: 1. The hepatitis C virus (HCV) test kit program was underwritten by Home Access Health as a grant to my BAART/CDP colleagues and myself in November 1999. 2. The HCV treatment described is manufactured by Schering Plough, with whom my BAART/CDP colleagues

The 128th Annual Meeting of APHA