The 130th Annual Meeting of APHA

Abstract #46575

Anita M. Loughlin, MS, Dept. of Epidemiology, Johns Hopkins School of Public Health, Rm 5010, 615 N. Wolfe Street, Baltimore, MD 21205, 410-303-8137, aloughli@jhsph.edu and Steffanie Strathdee, PhD, Department of Epidemiology, Johns Hopkins School of Public Health, Infectious Diseases Program, 615 N. Wolfe Street, Baltimore, MD 21205.

Introduction: The HCV epidemic is thriving in disadvantaged, marginalized drug users. Current national consensus guidelines do not recommend HCV treatment for drug or alcohol users or persons with mental illness. We evaluated HCV prevalence, correlates and barriers to HCV treatment among methadone maintenance treatment (MMT) clients. The feasibility and public health importance of providing HCV treatment to drug user in MMT is discussed. Methods: The ACCESS II study assessed HCV prevalence and barriers to medical care among MMT clients in Baltimore, MD. Correlates of HCV infection and barriers to HCV treatment were identified using logistic regression. Results: To date, among 558 MMT clients, HCV prevalence is 67.4% and exceeded 90% among clients who ever injected drugs or shared equipment. Correlates independently associated with prevalent HCV infection included age (OR=1.10 per year), annual income of <=$5,000 (OR=2.07), HIV infection (OR=2.18), prior HBV infection (OR=12.5), having received HBV vaccine (OR=3.61), years in MMT (OR=1.11 per year), current drug use (OR=0.48), IDU in past month (OR=13.9) and mental illness (OR=3.01). Four barriers – lack of medical insurance, current alcohol or drug use, and mental illness, would prevent 77% of the MMT participants from accessing HCV care or treatment. Conclusions: HCV testing and counseling, HBV and HAV immunizations, and ongoing medical care and treatment should be offered to MMT clients. The infrastructure of MMT provides a means to deliver treatment, maintain adherence and to monitor side-effects among drug using populations who can benefit from treatment.

Learning Objectives:

• To outline the unmet health care needs of HCV infected drug users.
• To demonstrate that it is time to develop a strategy to provide HCV care and treatment to drug users.
• To propose that MMT provide an infrastructure within which preventive care and HCV treatment can be provided to drug using populations.

Keywords: Hepatitis C, Methadone Maintenance

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.