Counseling and Case Management Increases Eligibility for HCV Treatment
Comorbid substance-use and mental-health disorders (SUD/MHD) among patients with chronic hepatitis-C virus (HCV) infection may lead clinicians to defer pegylated interferon (pegIFN) treatment. This randomized controlled study assessed the efficacy of a 9-month integrated-care intervention at improving pegIFN treatment eligibility among patients whose pegIFN treatment was deferred due to SUD/MHD. Patients (N=101) seen in a hepatology clinic, nearly half of whom were deferred due to an SUD, were randomized to receive written treatment recommendations from a hepatologist or written recommendations plus up to 9 months of monthly counseling along with case management to promote adherence to the recommendations. Hepatologists blinded to group assignment determined eligibility for pegIFN treatment at 3, 6, and 9 months based on self-reported adherence to treatment recommendations, clinical exam, and laboratory testing. At 9 months,
- 42% of patients in the intervention group (n=21) were deemed eligible for pegIFN treatment versus 18% in the control group (n=9) (p=0.009).
- 24% of patients in the intervention group (n=12) had started pegIFN treatment versus 14% in the control group (n=7) (p=0.21).