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).

Comments:

The finding that counseling along with case management promoted eligibility for pegIFN treatment lends support to the efficacy of this approach among patients with co-occurring SUD/MHD. The fact that so few patients in either group actually began treatment, regardless of the intensity of care, points to the ongoing need to find effective interventions to treat this vulnerable HCV-infected population.

Hillary Kunins, MD, MPH, MS

Reference:

Evon DM, Simpson K, Kixmiller S, et al. A randomized controlled trial of an integrated care intervention to increase eligibility for chronic hepatitis C treatment. Am J Gastroenterol. 2011;106(10):1777–1786.