Group treatment of chronic hepatitis C infection with direct-acting antiviral agents in a methadone program

Background: In our opiate agonist treatment program, providing Hepatitis C (HCV) treatment in a group setting has been a compelling model for treating complex patients with combination therapy (ribavirin and pegylated-interferon). Group treatment can increase patient motivation, provide powerful social support, promote retention in treatment, and increase medication adherence. Recently, the direct acting antivirals (DAA) telaprevir and boceprevir were approved to treat genotype-1 patients. While these agents promise increased cure rates, they present additional challenges (i.e. special dietary requirements, increased pill burden, and side effects ). In addition, excellent medication adherence is required to avoid drug resistance. It is unknown whether the group setting will facilitate the completion of HCV treatment with triple therapy among opiate agonist treatment patients. Method: Between August 2011 and January 2012, 13 genotype-1 HCV-infected patients initiated treatment with triple therapy, attending once-weekly groups. Each 60 minute group includes patient completion and provider review of assessment tools for side effects, adherence, and depression; administration of medication injections; brief physical exams; a facilitated discussion; and a short closing meditation. Results: Of the 13 patients who initiated group HCV treatment, one patient discontinued due to virologic nonresponse. All others (12; 92%) achieved a 4 week response with viral load < 43 IU/ml. The 4 patients that completed treatment had an end of treatment response. All other patients remain on treatment, including 2 patients who had significant telaprevir-associated rash. Conclusion: Group treatment is a promising model for treating patients receiving direct acting antivirals within opiate agonist treatment programs.