Online Program

An International Perspective on Using Medication-Assisted Therapy of Opioid Dependence to Improve Hepatitis C Virus Infection Prevention and Care for People Who Inject Drugs: Structural Barriers and Public Health Potential

Sunday, November 1, 2015

David C. Perlman, MD, Department of Medicine, Mount Sinai Beth Israel, New York, NY
Ashly E Jordan, MPH, New York University, New York, NY
Don C. Des Jarlais, PhD, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY
Anneli Uuskula, M.D., Ph.D., Department of Public Health, University of Tartu, Tartu, Estonia
Duong Thi Huong, MD PhD, Hai Phong University of Medicine and Pharmacy, Ngo Quyen, Hai Phong, Vietnam
Carmen Masson, PhD, Department of Psychiatry, University of California San Francisco, San Francisco, CA
Bruce Schackman, PhD, Cornell University, Weill Cornell Medical College, New York, NY
Issue:People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Medication assisted treatment (MAT) of opioid dependence has the potential to aid the public health response to HCV by 1) serving as primary HCV prevention, 2) treating non-injection opioid dependent people who might otherwise transition to drug injection, and 3) serving as a platform for HCV services.

Description: We examined programmatic, structural and policy considerations relevant to using MAT to improve HCV control in 3 countries—the United States, Estonia and Viet Nam.

Lessons Learned: In each country a range of interconnected factors affects the use MAT as a component of HCV control. These factors include 1) that MAT is not yet provided on the scale needed to adequately address illicit opioid dependence, 2) inconsistent use of MAT as a platform for HCV services, 3) high costs of HCV treatment and health insurance policies that affect both MAT and HCV treatment access, and 4) the stigmatization of drug use.

Recommendations: The following appear to be important for controlling HCV transmission among PWID: 1) maintaining current HIV prevention efforts, 2) expanding efforts to reduce the stigmatization of drug use, 3) expanding MAT as part of a coordinated public health approach to opioid dependence, and HIV and HCV control efforts, 4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention. The global expansion of MAT and its use as a platform for HCV services should be both a feasible next step in the public health response to the HCV epidemic, and is likely to be critical in efforts to eliminate or eradicate HCV.

Learning Areas:

Planning of health education strategies, interventions, and programs
Public health or related public policy
Public health or related research

Learning Objectives:
Discuss potential role of medication-assisted treatment in the public health response to hepatitis C virus infection. Discuss potential barriers and facilitators to implementing medication-assisted treatment as a component of hepatitis C virus infection control.

Keyword(s): Drug Abuse Treatment, Hepatitis C

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Extensive expertise in the management and treatment of substance abuse and related infections (including TB, HIV, HCV). Extensive expertise in the epidemiology and public health policy related to drug use, HIV, HCV, and MAT/NSP and combined prevention programming.
Any relevant financial relationships? No

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.