INTRODUCTIONData on the epidemiology of hepatitis C among individuals who use drugs in low-threshold settings are lacking, although crucial to assess the burden of disease and aid in the design of ...treatment strategies.
OBJECTIVEThe aim of this study was to characterize the epidemiology and disease related to hepatitis C in a population attending a low-threshold methadone program.
MATERIALS AND METHODSA cross-sectional study in the population attending the Mobile Low-Threshold Methadone Program in Lisbon, Portugal, was carried out. The survey included assessment of risk factors for infection with hepatitis C virus (HCV) and liver disease, HCV serology and RNA detection, HCV genotyping, and liver disease staging.
RESULTSA total of 825 participants were enrolled, 81.3% men, mean age 44.5 years. Injecting drug use (IDU) was reported by 58.4% – among these, 28.2% were people who inject drugs. Excessive drinking and HIV coinfection were reported by 33.4 and 15.9%, respectively. Among participants with active infection, 16.9% were followed up in hospital consultation. The overall seroprevalence for HCV was 67.6% (94.2% in IDU, 30.0% in non-IDU, 97.1% in people who inject drugs, and 75.6% in excessive drinkers). Among seropositives for HCV, active infection was present in 68.4%. Among individuals with active infection, the most common genotypes were 1a (45.3%) and 3a (28.7%), whereas 30% had severe liver fibrosis or cirrhosis. Age 45 years or older, HCV genotype 3, and coinfection with HIV were significant predictors of cirrhosis.
CONCLUSIONThis population has a high burden of hepatitis C and several characteristics that favor dissemination of infection. Healthcare strategies are urgently needed to address hepatitis C in this setting.
This study assesses treatment retention rate and identifies determinants associated with retention in a Canadian low-threshold methadone program. Relais-Methadone is a Montreal methadone program ...which serves marginalized clients who do not have ready access to conventional methadone treatment. In its first year of operation, 141 clients entered the program. Treatment retention was calculated over a six-month period. Age, sex, duration of heroin use, cocaine use, legal situation, source of income and injection with used needles were studied as determinants of retention. Results were based on both a screening and an evaluation questionnaire. Drug use, living conditions, and HIV-risk behaviours were documented. The retention rate in the first six months was 72%. Cocaine use was the main risk factor for treatment interruption. Being a woman, working in the sex trade, and not having a stable source of income also increased the risk of one's withdrawal from the program. Findings showed that, among those who dropped out of treatment, a large proportion was particularly at risk for HIV and other infectious diseases. Results indicated that particular attention should be paid to intravenous multi-drug users attending such programs.
