Habchi Jackie, Thomas Aurielle M, Sprecht-Walsh Sophie, Arias Elenita, Bratberg Jeffrey, Hurley Linda, Hart Susan, Taylor Lynn E
CODAC Behavioral Healthcare, Providence, Rhode Island, USA.
University of Rhode Island, Providence, Rhode Island, USA.
Open Forum Infect Dis. 2020 Oct 13;7(10):ofaa310. doi: 10.1093/ofid/ofaa310. eCollection 2020 Oct.
A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era.
We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island's only nonprofit methadone maintenance program.
Of 275 who initiated DAAs, the mean age (range) was 43 (22-71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25-202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45-120 minutes per patient.
DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.
少数阿片类药物使用障碍患者会接受丙型肝炎病毒（HCV）感染治疗。虽然丙型肝炎病毒和阿片类激动剂疗法（OAT）同地开展并结合减少伤害措施有助于预防并实现治愈，但在美国直接抗病毒药物（DAA）时代，很少有这种嵌入式护理模式的实际案例。
我们进行了一项回顾性病历审查，以确定在罗德岛唯一的非营利性美沙酮维持治疗项目中接受现场检测和治疗的个体在DAA上市的头5年期间的持续病毒学应答（SVR）和再感染率。
在275名开始使用DAA的患者中，平均年龄（范围）为43（22 - 71）岁，34.5%为女性，57.5%为基因1a型，23.3%有肝硬化，92%是医疗补助受助人。SVR为85.0%（232/273），而改良意向性治疗SVR为93.2%（232/249）；17名患者未实现SVR，2名患者在治疗结束后12周等待SVR结果，24名患者失访。在375.5人年的随访中发现30例再感染（发生率为7.99/100人年）。首次再感染的中位时间（四分位间距）为128（85.25 - 202.5）天。2018年7月1日前，72名患者在3.7年期间使用了DAA；医疗补助DAA限制解除后，109名患者在1.3年期间使用了DAA。预先授权（PA）流程需要多个步骤，罗德岛11家保险公司各不相同，每位患者需要45 - 120分钟。
DAA治疗在城市同地开展的OAT/HCV项目中的边缘化人群中有效。取消DAA限制有助于开始治疗。PA流程仍然是美国扩大治疗能力的一个可改变的障碍。
