Tel Aviv University, Israel
Background: Lack of information about the disease and administrative difficulties are major obstacles to hepatitis C virus (HCV) treatment among methadone maintenance treatment (MMT) patients.
Methods: HCV seropositive patients treated in the Adelson Clinic rehabilitation center who were abstinent ≥3 months without active psychiatric disorders were invited to a lecture by a Hepatologist on all aspects of HCV disease. During the period of the study, the standard of care for HCV treatment was PEG-RIBA+PI (telaprevir). The participants completed HCV-knowledge and depression questionnaires before and after the lecture and were then referred to evaluation and treatment in the Tel Aviv Medical Center Liver Unit.
Results: Of 80 eligible patients, 48 attended the lecture and following the lecture scored significantly better on knowledge about HCV than the non-attendees. Lecture attendance predicted referral to treatment (Odds ratio (OR)=13 (95% confidence interval (CI) I 3.9-44.9 P<0.0005)). Of the 41 referrals, 21(51.2%) actually presented at the Liver Unit, and had lower depression scores (OR=0.2, 95% CI 0.06-0.9 P=0.03). Despite administrative difficulties, 15 participants (71.4%) started evaluation, 12 (80%) initiated interferon-based antiviral treatment and 9 subjects (75%) achieved SVR (1 did not respond to treatment and 2 stopped due to adverse events). Of the 59 who were not present at the Liver Unit, 14 (23.7%) were followed elsewhere but only one of them (7.1%) started treatment.
Conclusions: Attendance in a single lecture about HCV, improved knowledge and enhanced HCV treatment initiation among MMT patients, but was adversely affected by depression. In MMT patients, interventions aimed to minimize administrative difficulties and to increase knowledge and awareness to the disease, as well as treatment of depression are necessary. These measures might be even more effective at present, when safe and effective IFN-free therapies to eradicate HCV are widely available.