Hepatitis C Virus (HCV) elimination and the opioid crisis: joint problems, joint solution – results of a pilot programme
Background: People who use drugs (PWUD) in Canada are disproportionately affected by both the Hepatitis C virus (HCV) and opioid overdose epidemics. In Vancouver, there is approximately one overdose-related death daily. Many models focus primarily on addiction-related interventions in isolation. These could be supplemented by efforts to address HCV infection, to enhance the benefits of overall care.
Methodology: A retrospective chart review of HCV-infected patients with a history of drug use was conducted. All patients enrolled at our centre have access to multidisciplinary care to address medical, social, psychiatric, and addictions-related needs in an integrated manner. All strategies are focused on maintenance of long-term engagement in care.
Results: Since 2014, 348 individuals have initiated HCV treatment, demographic characteristics are as follows: mean age 53 years, 21% female, 52% with a psychiatric diagnosis, 23% homeless, 15% co-infected with HIV, 54% on OST. To date, 252 have reached the SVR12 time-point, 247 of whom have achieved SVR12 (98% cure rate), while 3 experienced virologic relapse and will require re-treatment and 2 discontinued treatment prematurely. Within this cohort, current injection drug use confirmed in 195 individuals, and 30 medically significant overdoses have occurred in 25 individuals, including three deaths. The demographics of this population are: mean age 52 years, 17% female, 70% on OST, 13% HIV co-infected, 35% homeless, 74% with a confirmed psychiatric diagnosis. All of the three individuals who died of an overdose were male, ages 26, 38, and 55 years, one on OST, two were co-infected with HIV, two unstably housed, two with a psychiatric diagnosis.
Conclusion: Addressing both upstream needs such as secure housing, income, and food, in addition to the downstream manifestations of these issues, such as HCV infection and substance use disorders is one model which may be effective way to reduce both HCV and opioid-related harms, as well as affect long term health and quality of life of this population. Additional resources should be dedicated to those with unstable housing and psychiatric diagnoses, who are a particularly vulnerable population. The model we have developed could scaled up to address the many complex needs of this highly vulnerable population and may be an essential part of a concerted response to the opioid crisis.