Integrated viral hepatitis care for methadone maintenance treatment (MMT) patients-results from a RCT

Aim: Intervention coordinating hepatitis care for MMT patients. Methods: MMT participants were recruited in New York City and San Francisco and randomized to either: 1) on site HIV and hepatitis (HAV/HBV/HCV) screening, education with motivational interviewing (MI), HAV/HBV vaccination, and 6 months of case management (CM) to promote adherence to HCV evaluation (HCC arm), or 2) on-site HIV and hepatitis screening, education, and referral for off site HAV/HBV vaccination and HCV evaluation (TEC arm). Results: Of the 489 participants, 32% were female; 31% Hispanic, 29% Black, 36% White; mean age 45 years; 70% reported injection drug use (ever); 41% were homeless in past 6 months; mean methadone dose 90mg; 10% were HIV infected. Overall 299 (61%)participants needed HAV/HBV vaccine, 286 (58%) needed HCV evaluation, and 144 (29%)needed both. HCC participants were independently more likely to be vaccinated within 30 days (76% vs. 11%; p < 0.001; OR: 42.3; 95% CI: 19.5-91.9) and were more likely to attend an HCV evaluation during the CM period (53% vs. 33%; p < 0.001; OR: 2.3; 95% CI: 1.4-3.9). Overall HCC participants were independently more likely to adhere to needed hepatitis interventions (ie., vaccination only, HCV evaluation only, or both [54% vs. 16%; OR: 6.7; 95% CI: 4.3-10.5]). Conclusions: A comprehensive hepatitis care coordination model, with on site vaccination, MI enhanced education and case management, integrated in MMT increased adherence to HAV/HBV vaccinations and HCV evaluations, demonstrating the effectiveness of an integrated viral hepatitis care model in MMT.