Hepatitis C Virus (HCV) Care Continuum Outcomes and HCV Community Viral Loads Among Patients in an Opioid Treatment Program

• Published in: The Journal of infectious diseases Vol. 222; no. Supplement_5; pp. S335 - S345
• Main Authors: Jordan, Ashly E, Cleland, Charles M, Schackman, Bruce R, Wyka, Katarzyna, Perlman, David C, Nash, Denis
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 02.09.2020
• Subjects: Adolescent; Adult; Aged; Continuity of Patient Care; Drug addiction; Endemic Diseases - prevention & control; Endemic Diseases - statistics & numerical data; Female; Geography; Health Services Needs and Demand - organization & administration; Health Services Needs and Demand - statistics & numerical data; Hepacivirus - isolation & purification; Hepatitis; Hepatitis C; Hepatitis C - diagnosis; Hepatitis C - epidemiology; Hepatitis C - therapy; Hepatitis C - transmission; Humans; Male; Methadone - therapeutic use; Middle Aged; Narcotics; New York City - epidemiology; Opiate Substitution Treatment - statistics & numerical data; Opioid Epidemic - statistics & numerical data; Opioid-Related Disorders - complications; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - rehabilitation; Opioids; Professional Practice Gaps - organization & administration; Professional Practice Gaps - statistics & numerical data; Supplement; Viral Load; Young Adult; New York City; opioid use disorder; hepatitis C virus; people who use drugs; community viral load; injection drug use
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiz686

Abstract Background Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. Methods Data from patients in an opioid treatment program during 2013–2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013–2014 and 2015–2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and “documented” and “estimated” unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. Results Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013–2014 vs 73.3% in 2015–2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. Conclusions After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.