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Learning Objective:
Participants will be able to identify adaptations for HCV education, evaluation and treatment among patients with substance use disorders (SUD).
Background:
Patients with SUD's are at high risk for HCV, require education, testing, counseling and treatment, if appropriate. Integrated delivery of care for HCV, SUD and psychiatric disorders within addictions clinics may address obstacles to treatment in Hepatology clinics.
Setting:
Addictions Treatment Clinic (ATC) in urban VA medical center wtih HCV services provided by addictions ARNP consulting with Hepatologists.
Population e.g. API Youth, MSM, IDU:
Veterans presenting for specialty treatment of SUD (alcohol, stimulant, opioid and cannabis dependence) and a range of psychiatric comorbidity (depression, bipolar, anxiety, schizoaffective, PTSD and obsessive-compulsive disorders).
Project Description:
ATC patients attend a required introductory HCV class adapted to SUD issues, then individual evaluation of viral status and treatment appropriateness. When indicated, patients receive interferon-based treatment on site. Twelve veterans have been treated in ATC to date.Treatment includes weekly evaluation for the first month, then monthly. Those with severe psychiatric comorbidity continue weekly.
Results/Lessons Learned:
Since Septermber, 2003 over 500 patients have attended the education class. Anecdotally, staff reports a positive effect of class on motivation and abstinance. SUD patients demonstrate stability, committment and compliance with antiviral regimens. Frequent patient contact and inter-provider communication are critical for monitoring side-effects, functional/psychiatric status, cravings and additional support through addictions treatment. There have been few somatic complaints though many discontinue treatment due to the severity of side-effects, and a strong reluctance to discontinue treatment is notable. Preexisting PTSD and depression have been associated with increased irritability. Relapse and drug craving have not been problematic despite self-injections and possession of syringes. Veterans voice a preference for treatment in ATC and describe strong support within addicitions groups. Providing HCV treatment in ATC offers a well-accepted alternative to Hepatology clinics.
See more of D4 - Integrating HCV Prevention in Substance Abuse Programs
See more of The 2005 National Viral Hepatitis Prevention Conference