Patients who inject drugs and have hepatitis C virus (HCV) are more likely to receive regular health care from a physician for HCV if they are enrolled in a methadone maintenance therapy (MMT) program, according to the results of a Canadian study published in PLoS One.
Up to 80% of people who inject drugs are HCV positive, and chronic HCV infection contributes disproportionately to morbidity, mortality, and poorer quality of life among injection drug users. Reducing the rate of HCV infection and transmission in this population and the population as a whole requires adequate access to health care, but studies have shown that only 1% to 6% of people who inject drugs have ever been treated for HCV.
Lianping Ti, PhD, of the British Columbia Centre for Excellence in HIV/AIDS and the Department of Medicine at the University of British Columbia in Vancouver, Canada, and colleagues used 3 open prospective cohort studies — the Vancouver Injection Drug Users Study (VIDUS), the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), and the At-Risk Youth Study (ARYS) to identify 1627 HCV-positive people who injected drugs between September 2005 and May 2015. They used a marginal structural model and inverse probability of treatment weights to estimate the longitudinal relationship between being enrolled in MMT and having a regular HCV physician and/or specialist.
A substantial majority of participants — 83.4% (n=1357) — accessed medical care for HCV at least once during the study period. Those enrolled in an MMT program had 2.12 greater odds of having a regular HCV physician than those who were not enrolled.
The study is limited by the observational nature of the study design, the use of data derived from self-report, the assessment of chronic HCV status based on HCV-antibody positive test results, and the lack of randomization.
The investigators suggest that enrollment in an MMT program may be helpful in providing access to HCV care in people who inject drugs. They argue that these findings also underscore the need to make a more concerted effort to involve drug users in substance use care.
Ti L, Socias ME, Wood E, et al. The impact of methadone maintenance therapy on access to regular physician care regarding hepatitis C among people who inject drugs. PLoS One. 2018;13:e0194162.