In the OTP, methadone is dispensed on site, via a mobile unit (Intercity Methadone Bus), and in five community pharmacies.
The selection process of the study population was conducted in the only addiction clinic for the provision of methadone in both cities during the study period. The OTP operates in a municipal outpatient clinic specialized in the treatment of SUDs in Badalona (240000 inhabitants) and Santa Coloma de Gramenet (120000 inhabitants), Spain. This longitudinal study included ex-heroin users enrolled in an OTP between October 2015 and September 2017.
Therefore, we studied OTP participants to analyze assessment of infection, treatment rates, and predictors of treatment with DAAs. We hypothesized that in the context of the changes made in the provision of HCV care, OTP sites might be experiencing increasing proportions of patients that are eligible for HCV treatment. A previous study on individuals that participated in Opioid Treatment Programs (OTPs) in Catalonia, Spain, showed that the prevalences of HCV and human immunodeficiency virus (HIV) infections were 74% and 54%, respectively. Individuals treated with methadone might have a history of injected drug use, and consequently, they might have acquired blood-borne infections, like HCV, after they began injecting drugs. At the same time, up to 60000 patients are regularly treated with opioid agonist therapy ( i.e., methadone) in Spain. More than 120000 people have been treated with DAAs since the Strategic Plan for Tackling Hepatitis C was implemented by the Spanish National Health System in 2015. Indeed, several studies have indicated that SUDs did not affect adherence to treatment or imply worse response rates. All of these organizations recommend DAAs for treating HCV infection, including in individuals with SUD. The strategy is to promote a cascade of care, or a continuum of services that should be provided to cure HCV in persons living with hepatitis.Ĭurrent guidelines for HCV care and treatment are provided, among others, by the American Association for the Study of the Liver (AASLD), the European Association for the Study of the Liver (EASL), and the WHO. In this context, individuals with SUD have been recognized as a target population for improving the identification of HCV-related disease and for implementing HCV micro-elimination strategies. The defining features of that goal are to achieve a 90% reduction in new cases, diagnose 90% of all individuals infected with HCV, treat 80% of those eligible, and reduce death by 65%. The WHO aims to eliminate HCV infection by 2030. Several studies have revealed that DAAs showed efficacy in difficult-to-treat populations, including individuals with SUD.
Pharmacotherapy for HCV infection is administered for shorter periods of time ( i.e., 8-12 wk) and sustained virological responses (SVR) are achieved in over 90% of patients, irrespective of the HCV genotype. The introduction of direct-acting antiviral agents (DAAs) in 2013 caused substantial changes in the clinical outcomes of HCV infection. In the United States and western Europe, two out of every three new HCV infections are believed to be associated with substance use. According to the World Health Organization (WHO), 23% of new HCV infections occur in patients with SUD. In addition, it is believed that a proportion of HCV infections remain undiagnosed in individuals with SUD. It is estimated that 10 million people with substance use disorder (SUD) have hepatitis C virus (HCV) infection.