Date Published: April 25, 2018
Publisher: BioMed Central
Author(s): Stephen A. Martin, Jordon Bosse, Amanda Wilson, Phyllis Losikoff, Lisa Chiodo.
For over a decade, the vast majority of new hepatitis C virus (HCV) infections have been among young people who inject drugs (PWID). Well-characterized gaps in chronic HCV diagnosis, evaluation, and treatment have resulted in fewer than 5% of PWID receiving HCV treatment. While interferon-based treatment may have intentionally been foregone during part of this time in anticipation of improved oral therapies, the overall pattern points to deficiencies and treatment exclusions in the health care system. Treatment for HCV with all-oral, highly effective direct-acting antiviral medication for 12 weeks or less is now the standard of care, putting renewed focus on effective delivery of care. We describe here both the need for and process of chronic HCV care under the roof of addiction medicine.
Two profound changes in chronic hepatitis C virus (HCV) infection have occurred over the past decade. The first is the availability of medications that allow an all-oral highly effective cure. These direct-acting antiviral (DAA) agents have few adverse effects and enable treatment completion in as little as 8–12 weeks, with success rates exceeding 90% . They are sorely needed given that HCV is now the leading cause of infectious death in the United States  and the most common cause of liver transplant .
Over the past year, we have been learning from the pilot provision of HCV treatment as part of meeting our patients’ health needs—independent of primary care and eliminating multiple steps of the usual HCV treatment cascade (Table 1). CleanSlate Addiction Treatment Centers offers dedicated treatment for opioid and alcohol use disorders in eight states, with clinicians that include social workers, advanced practice clinicians, and physicians. Patients in treatment for OUD at CleanSlate have a median age of 36 years old, with 26% under the age of 30 and 64% under the age of 40. As such, they represent the demographic profile of the younger person with OUD and an elevated risk of chronic HCV infection. As the treatment cascade makes clear, caring for a group of patients with a high burden of chronic HCV does not inevitably lead to its cure; the combination of an effective treatment strategy together with longitudinal care is especially helpful. The average length of treatment in our buprenorphine program is over one year (SD = 1.3, range 0.2–5.5). This timeframe is well beyond the 12 weeks of HCV treatment needed and allows providers more time with their patients to develop therapeutic relationships. Additional time spent with patients allows providers to assess patients’ stability and motivation for treatment and provide education, which, in the context of the therapeutic relationship, can maximize adherence to treatment.
People with chronic HCV currently face fragmented care provision, including diagnosis and cure of chronic HCV. Addiction treatment programs are uniquely situated to either use their existing program infrastructures or expand current programming to increase access to HCV care and treatment. By recognizing the unique, trusted, ongoing clinical role we play in many patients’ lives, we can help their health beyond addiction.