261621 Group treatment of chronic hepatitis C infection with direct-acting antiviral agents in a methadone program

Tuesday, October 30, 2012

Robert Roose, MD, MPH , Division of Substance Abuse, Albert Einstein College of Medicine, Bronx, NY
Irene Soloway, PA , Division of Substance Abuse, Albert Einstein College of Medicine, Bronx, NY
Lauren Cockerham-Colas, MPH , Division of Substance Abuse, Albert Einstein College of Medicine, Bronx, NY
Alain Litwin, MD, MPH, MS , Division of Substance Abuse, Albert Einstein College of Medicine, Bronx, NY
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.

Learning Areas:
Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Explain the potential benefits of utilizing a group model for treatment of Hepatitis C. Identify key components that comprise the group treatment model. Discuss potential applications of the group treatment model for other healthcare settings.

Keywords: Hepatitis C, Treatment System

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am board certified in internal medicine and addiction medicine, and have been providing medical care to drug users with complex social, psychiatric and medical needs within an integrated primary care and methadone maintenance treatment program for over 10 years. My research (funded by NIH, CDC, AHRQ, and RWJF) is focused on developing and studying models of HCV care for drug users, and on advocating for increasing access to effective care for HCV-infected patients.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Vertex and Merck HCV Advisory Committee/Board

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.