Providing psychiatric services for hepatitis C virus patients with substance use disorders

Introduction:

Since the introduction of Direct Antiviral Agents (DAA) in 2016, patients with HCV have an excellent chance of finding a cure for their condition. Among the demographic groups of patients that are at risk of being affected by HCV are: drug abusing individuals via injections, people that were born in the Soviet Union, and patients that received blood transfusions before 1992 (due to absence of vaccinations). Drug abusing patients have a low compliance to medical services, which includes the consistency of using HCV treatment. In addition to that, patients with acute psychosis are at an independent risk to be affected by HCV. Only about 5% of these, are being screened for the presence of the virus.Mentally ill patients that also have SUD (Substance Use Disorder), have additional risk factors to be infected with HCV. In 2016, an innovative model was introduced in collaboration with the medical center "Wolfson", to treat patients during their psychiatric hospitalization. Since 2018, hospitalized patients were screened within the Dual Diagnosis of Mental Illness ward.

Objectives:

Retrospective analysis of routinely collected data.In order to analyze the efficacy of the model. Demographic data such as: age, gender, family healthcare system support, living conditions, and imprisonment history will be taken into account. In addition, clinical data such as: stage of fibrosis, serologic results for HCV and HIV, medical background and medications, along with psychiatric data such as: Substance use, diagnostic records, number and length of hospitalizations.

Methods:

Those who are diagnosed with HCV were examined at the facility by the project's expert hepatologist including a full workup. The treatment was administered during hospitalization by the nursing staff. Patients that were released from the facility were referred to treatment, and follow-up at the Hepatology Clinic through their case manager at the DDW. We were with close contact with family physicians, rehab centers, MHO and families of our patients to provide the most effective support and efficiency to our project. Potential DDIs were evaluated before the administration of DAAs using a web interaction-checker and changes in co-medications due to DDIs were also recorded. During treatment, all patients routinely underwent monthly monitoring, including clinical and laboratory assessment.

Results:

We present a novel model of treating HCV in special populations that require service at every step of investigation and treatment. Our team works closely with a psychiatric center, rehab centers, social services, HMOs (control, approvals), GPs (prescriptions) and patients' families, in order to optimize patient inclusion and adherence.

Conclusions:

There is a fundamental clinical and scientific work concerning adjustment of psychiatric and somatic interventions for hepatis C virus patients with substance use disorder, discovering new approaches for the future practice.