A Randomized Trial of a Hepatitis Care Coordination Model in Methadone Maintenance Treatment

Carmen L. Masson, Kevin L. Delucchi, Jennifer Hettema, Nicole Pepper, Jessica Hall, Nicholas S. Hengl, Michael S. Shopshire, Jennifer K. Manuel, Bradley Shapiro, and James L. Sorensen are with the Department of Psychiatry, Mandana Khalili is with the Department of Medicine, and Hali Hammer is with the Department of Family and Community Medicine, University of California, San Francisco. Courtney McKnight, Albert Min, Ashly E. Jordan, Christopher Young, Lara Coffin, Randy M. Seewald, Henry C. Bodenheimer, Jr, Don C. Des Jarlais, and David C. Perlman are with the Beth Israel Medical Center, New York, NY.
American Journal of Public Health (Impact Factor: 4.55). 08/2013; 103(10). DOI: 10.2105/AJPH.2013.301458
Source: PubMed


We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients.

We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n = 245) and an intervention arm (n = 244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services.

Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR] = 41.8; 95% confidence interval [CI] = 19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR = 4.10; 95% CI = 2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV-HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR = 8.70; 95% CI = 5.56, 13.61).

Hepatitis care coordination was efficacious in increasing adherence to HAV-HBV vaccination and HCV clinical evaluation among methadone patients.

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    • "L. Masson, et al., 2013) However, neither co-located models nor linkage models are widely implemented. (Bruggmann & Litwin, 2013; Masson, et al., 2013; Perlman, et al., 2014) In the U.S., in addition to available MMT slots, buprenorphine is also available by prescription for opioid dependence. However, the implementation of buprenorphine as OST has been limited by variations in State regulations governing its use, by costs and insurance coverage limitations, by limitations in the number of providers who are credential to prescribe it and actually do so, and by caps in the number of patients any given credential provider can treat. "
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    ABSTRACT: People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries-the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include (1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, (2) inconsistent use of OST as a platform for HCV services, (3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and (4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: (1) maintaining current HIV prevention efforts, (2) expanding efforts to reduce the stigmatization of drug use, (3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, (4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV. Copyright © 2015 Elsevier B.V. All rights reserved.
    International Journal of Drug Policy 04/2015; 26(11). DOI:10.1016/j.drugpo.2015.04.015 · 2.40 Impact Factor
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    • "Thus, results from this study may have the potential to inform the development of future hepatitis education services for this high-risk group. We conducted a two-site randomized controlled trial of a motivational interviewing (MI) enhanced case management intervention designed to promote hepatitis A/B vaccination and HCV clinical evaluation among methadone patients, as part of which all participants were given a manual-guided two-session education and counseling intervention focused on viral hepatitis (Masson et al. 2013). Control condition participants were presented with hepatitis educational material in one on one didactic teaching sessions, and in the MI-enhanced case management condition, the interventionist presented the educational material in a collaborative style that is consistent with the principles of MI (Miller & Rollnick, 2013). "
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    ABSTRACT: The aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.
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