The Increasing Role of Methadone Clinics for HCV Treatment, Education

Injection drug users express willingness to gain knowledge, receive therapy.

Methadone clinics are emerging as an important setting for the education and treatment of patients with hepatitis C virus infection. Programs such as the START Treatment and Recovery Centers in New York City are leading the way in providing a venue for individuals not only to kick their addiction to opiates, but also to receive screening for HCV, learn about disease prevention measures and stay on course with treatment.

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“Providing methadone under close supervision allows us to provide educational and vocational services,” Roberto Zavala, MD, continuous quality improvement manager and researcher at the START Treatment and Recovery Center, said in an interview. “The methadone clinic model was successful with HIV, and now we are applying many of those same strategies to HCV.”

HCV intervention programs based in methadone clinics are still in the early stages, according to Zavala. Stigma and misinformation surrounding HCV continue to pose challenges in getting patients tested, and the advent of novel direct-acting antiviral therapies has resulted in a need for training clinicians and patients in treatment schedules and the diminution in adverse events as a consequence of elimination of interferon. There also are technological hurdles to clear, such as how to bring specialty care to the drug treatment facility. One potential answer to this dilemma is the use of telemedicine — technology that permits patient interaction with an HCV specialist in a remote location.

HCV Next Editorial Board member Andrew H. Talal, MD, MPH, said HCV diagnosis at a methadone clinic may be a “teachable moment” that clinicians can use as a jumping-off point to encourage patients to make healthier choices.

“Long-term stability on methadone may enable persons who inject drugs to stabilize their lives, thereby increasing the likelihood that they will be adherent to HCV medications,” said Talal, professor of medicine in the division of gastroenterology, hepatology and nutrition at University at Buffalo, State University of New York, and adjunct associate professor of medicine at Weill Cornell Medical College.

A STARTing Point

Methadone programs such as the START Treatment and Recovery Center may play a big role in the future of HCV treatment, Zavala told HCV Next.

The program is set up to “provide primary care onsite that can be supplemented for diseases that require specialty care such as HCV through the use of telemedicine. This has been a major advance for us that helps keep patients compliant with referrals and on track with their treatments. Many of our patients come to the clinic on a daily basis, where they can receive assessment, evaluation and treatment in a familiar setting, with medical personnel they know. They leave satisfied with this one-stop shop,” he said.

Recent data support the effectiveness of programs such as START.

Marija Zeremski, PhD, along with Talal, Zavala and other colleagues, created a 30-item survey about HCV knowledge that was completed by 320 patients on methadone maintenance in the START program. The survey is part of the Prevention, Evaluation and Treatment of HCV in Opiate Agonist Treatment Settings (PET-C) study, which is being conducted in collaboration with researchers at University at Buffalo, Weill Cornell Medical College, START and the CDC. The results were published in the Journal of Addiction Medicine.

The survey respondents had been receiving methadone maintenance for an average of 7 years. The mean age of respondents was 53 years, 60% were men, 55% were black and 40% were Hispanic.

Nearly 7% of respondents reported using injection drugs in the preceding 6 months, and 37.3% had used non-injection drugs. Half (46.3%) self-reported HCV seropositivity. Seventy-eight percent of respondents expressed willingness to participate in HCV education and treatment programs.

More than half (54.7%) of the respondents correctly answers five or more of seven questions about HCV, demonstrating a good fund of knowledge of the infection. As the researchers expected, those with HCV or those who had received prior education about the infection were more likely to demonstrate increased knowledge about HCV.

Some groups were more willing than others to accept HCV therapy, including those who were younger, those willing to attend an HCV-related educational activity and those with more knowledge about HCV. Patients who avoided treatment cited fear of adverse events associated with medication as the main reason.

“These new findings support the premise that addiction-treatment facilities can help provide sustained HCV treatment for this population. These facilities have the added advantage of being able to link HCV care to drug treatment, allowing for closer patient evaluation, which will likely lead to improved adherence to treatment regimens,” Talal said in a press release.