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Learning Objectives for this Presentation:
By the end of the presentation participants will be able to treat more methadone patients with hepatitis C.
Background:
Hepatitis C is an epidemic perpetuated by drug abuse and carriers who are often without social or medical resources and are rejected by society. Methadone clinics offer an opportunity to reach and treat the infected but the challenges are great.
Methods:
We undertook an educational program on viral hepatitis for a local methadone program. Of 150 clients 32 thought they had active hepatitis C and volunteered for a study comparing directly-observed with self-administration therapy with pegylated interferon and ribavirin.
Results:
The average age was 48 years. Ten were female. Four had a negative antibody for HCV and 2 had viral loads under 10. Thirteen had genotype 1, 5 type 2, 3 type 3 and 1 type 6. 14 had viral loads over 10 million and 4 were over 50 million. Two had active hepatitis B but none had HIV. 13 were homeless, 7 had no phone, and 4 had no medical insurance. Eighteen had a “dirty” urine within the last month. Initial Beck scale scores were over 20 in 14 and over 30 in 6. A psychiatric evaluation eliminated 2. Four reported daily alcohol consumption. Two decided not to start therapy. Six were eliminated by strict study timing and laboratory exclusions but will likely be treated when resources are available. The remaining 12 have been started on therapy and are responding well.
Conclusions:
Our investigations indicate a reasonable level of interest in therapy for hepatitis C can be generated in a methadone program but that there are many challenges and constraints. More housing, medical benefits, support, and counseling are needed for effective treatment. These efforts would save lives, limit the spread of disease, and likely be cost-effective.
See more of Poster Session #2
See more of The 2005 National Viral Hepatitis Prevention Conference