Providing Directly Observed HCV Treatment at a Methadone Maintenance Program is Feasible and May Improve Treatment Outcomes

In this pilot study, subjects in a methadone maintenance program who met criteria for treatment of HCV were randomized to receive self-administered treatment through a hepatitis clinic (SAT) or directly-observed treatment at the methadone maintenance program (mDOT). Over a 3-year period, 21 subjects were recruited. Preliminary outcomes were as follows:

Comments:

Although the numbers are too small to draw definitive conclusions, this study shows that directly observed HCV treatment can be provided in a methadone maintenance clinic and may improve treatment outcomes for a very select group of patients. The investigators were only able to recruit 7 subjects per year, and they do not tell us how many patients were not considered to be good candidates or declined treatment. Aside from patient factors, another barrier to implementation of programs like this is the need for additional training and time demands on staff.

Darius A. Rastegar, MD

Reference:

Bruce RD, Eiserman J, Acosta A, et al. Developing a modified directly observed therapy intervention for hepatitis C treatment in a methadone maintenance program: implications for program replication. Am J Drug Alcohol Abuse. 2012;38(3):206–212.