Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2020; 26(38): 5874-5883
Published online Oct 14, 2020. doi: 10.3748/wjg.v26.i38.5874
Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study
Arantza Sanvisens, Inmaculada Rivas, Eva Faure, Néstor Espinach, Anna Hernandez-Rubio, Xavier Majó, Joan Colom, Robert Muga
Arantza Sanvisens, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain
Inmaculada Rivas, Eva Faure, Néstor Espinach, Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
Anna Hernandez-Rubio, Robert Muga, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona 08916, Spain
Xavier Majó, Joan Colom, Program on HIV, STIs and Viral Hepatitis - PCAVIHV Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona 08005, Spain
Author contributions: Sanvisens A and Muga R designed the study and wrote the first draft of the manuscript; Sanvisens A managed the literature searches and statistical analysis; Rivas I, Faure E, Espinach N, and Hernandez-Rubio A recruited the study population and took care of patients; Sanvisens A, Rivas I, Majó X, Colom J and Muga R reviewed the literature and made contributions to the interpretation of data; and all the authors contributed to the discussion section and revised and approved the final manuscript.
Supported by the Ministry of Science, Innovation and Universities, Carlos III Health Institute (ISCIII), European Fund for Regional Development (FEDER), Network for Cooperative Research in Health (RETICS), Spain (No. RD16/0017/0003, PI17/00174, INT19/00026, CD19/00019); the Ministry of Health, National Plan on Drugs (PNSD), Spain (No. 2018/020); the European Commission (806996-JUSTSO-JUST2017-AG-DRUG); the Gilead Fellowship Program, Gilead Sciences (No. GLD17/187); the Ministry of Education, Spain (No. PRX18/00245); the Agency for Management of University and Research Grants, Government of Catalonia (No. 2017SGR316); and the Municipal Institute of Personal Services-IMSP, Badalona.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Hospital Universitari Germans Trias i Pujol (PI-15-100), Badalona, Spain.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Robert Muga, MD, PhD, Professor, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Ctra. canyet s/n, Badalona 08916, Spain. rmuga.germanstrias@gencat.cat
Received: June 9, 2020
Peer-review started: June 9, 2020
First decision: July 29, 2020
Revised: August 12, 2020
Accepted: September 17, 2020
Article in press: September 17, 2020
Published online: October 14, 2020
Processing time: 127 Days and 1.5 Hours
ARTICLE HIGHLIGHTS
Research background

The introduction of direct-acting antiviral agents (DAAs) is associated with substantial changes in clinical outcomes of hepatitis C virus (HCV) infection. In this context, individuals with substance use disorder (SUD) have been recognized as a target population for the treatment of HCV infection.

Research motivation

Retention in treatment of SUD is key for the assessment and cure of HCV. In HCV infection, up to 80% of persons who inject drugs are infected but only a proportion is on treatment. In this sense, it is important to know real-life data in drug use populations. The Opioid Treatment Program (OTP) in metropolitan Barcelona, Spain, reports an increasing proportion of patients that are eligible for HCV treatment with DAAs.

Research objectives

Our main objective was to assess HCV infection status and treatment rates in a population primarily admitted for the treatment of SUD. Given the longitudinal nature of the study we aimed to identify gaps and challenges in using DAAs. In doing so we hypothesized on potential barriers that difficult the access to treatment in this population.

Research methods

We specifically analyzed annual treatment rates with DAAs in the context of HCV mono-infection and human immunodeficiency virus (HIV) co-infection. In addition, we estimated the cumulative incidence and main predictors of HCV treatment.

Research results

Results confirm a high prevalence of HCV infection in the OTP (67%) and the increasing rates of treatment over time. Almost 50% of HCV-positive patients were treatment naive (as of September 2019) in a health care system without restrictions in terms of insurance coverage. Patients with ongoing drug use and those with HCV mono-infection were less likely to be treated with respect to those with HIV co-infection.

Research conclusions

To the best of our knowledge this is the first study in Spain reporting on HCV treatment rates with DAAs in an OTP. We conclude that treatment rates increase over time and that higher rates are observed in the HIV-coinfected. The observed differences may be related to the lack of integrated care services for the HCV mono-infected. In addition, current drug use has an impact on the readiness to treat HCV infection.

Research perspectives

The goal of HCV elimination requires targeted interventions to identify those out of care and to implement strategies focused on traditional and local barriers. Surmounting barriers is necessary to eradicate HCV infection in people seeking treatment of SUD. The integrated management of liver disease with hepatologists, infectious diseases and addiction specialists may have an impact in reducing end stage liver disease.