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Observational Study
. 2016 Nov 15;11(11):e0166451.
doi: 10.1371/journal.pone.0166451. eCollection 2016.

Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study

Håvard Midgard  1   2 , Jørgen G Bramness  3 , Svetlana Skurtveit  3   4 , John W Haukeland  5 , Olav Dalgard  1   2
Affiliations
Observational Study

Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study

Håvard Midgard et al. PLoS One. .

Abstract

Background and aims: There is limited data on hepatitis C (HCV) treatment uptake among people who inject drugs including individuals receiving opioid substitution treatment (OST). We aimed to calculate cumulative HCV treatment uptake, estimate annual treatment rates, and identify factors associated with HCV treatment among individuals who have received OST in Norway.

Methods: This observational study was based on linked data from The Norwegian Prescription Database and The Norwegian Surveillance System for Communicable Diseases between 2004 and 2013. Both registries have national coverage. From a total of 9919 individuals who had been dispensed OST (methadone, buprenorphine or buprenorphine-naloxone), we included 3755 individuals who had been notified with HCV infection. In this population, dispensions of HCV treatment (pegylated interferon and ribavirin), benzodiazepines, selective serotonin reuptake inhibitors and antipsychotics were studied.

Results: Among 3755 OST patients notified with HCV infection, 539 (14%) had received HCV treatment during the study period. Annual HCV treatment rates during OST ranged between 1.3% (95% confidence interval [CI] 0.7-2.2) in 2005 and 2.6% (95% CI 1.9-3.5) in 2008 with no significant changes over time. HCV treatment uptake was not associated with age or gender, but associated with duration of active OST (adjusted odds ratio [aOR] 1.11 per year; 95% CI 1.07-1.15), high (> 80%) OST continuity (aOR 1.62; 95% CI 1.17-2.25), and heavy benzodiazepine use (aOR 0.65; 95% CI 0.49-0.87).

Conclusions: Cumulative HCV treatment uptake among OST patients notified with HCV infection in Norway between 2004 and 2013 was 14%. Annual treatment rates during OST remained unchanged below 3% per year. High continuity of OST over time and absence of heavy benzodiazepine use predicted HCV treatment uptake. Increased awareness for HCV among OST patients is needed as tolerable and efficient directly acting antiviral treatment is being introduced.

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Conflict of interest statement

HM has held sponsored lectures for Roche, Medivir, Gilead Sciences, MSD and AbbVie. OD has received research grants from Gilead Sciences and MSD, been a consultant for Medivir, AbbVie, MSD and Bristol Myers Squibb, and held sponsored lectures for Medivir, Bristol Myers Squibb, Abbvie and Gilead. JGB, SS and JWH have declared no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Study population (n = 3755).
Fig 2
Fig 2. Annual hepatitis C treatment uptake during opioid substitution treatment (n = 3755).
Dots indicate estimated treatment rates and bars represent 95% confidence intervals.
Fig 3
Fig 3. Venn diagram illustrating the relationship between all opioid substitution treatment (OST) patients (n = 9919), OST patients notified with hepatitis C virus (HCV) infection (study population; n = 3755) and all OST patients treated for HCV infection (n = 943).
Of all OST patients, 38% were notified with HCV infection. Of all patients treated for HCV infection, 57% were notified with HCV infection.
See this image and copyright information in PMC

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Grants and funding

HM received research funding (PhD scholarship) from the Norwegian ExtraFoundation for Health and Rehabilitation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.