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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    • "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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