Improving access to direct acting antivirals via a multimodal integrated care program in an addiction medicine clinic

Injection drug use is a driver of hepatitis C virus (HCV) transmission, thus integrating HCV care into addiction care is likely necessary for HCV elimination. Here we describe how we integrated HCV care into our addiction medicine (AM) clinic and evaluate its effect on HCV treatment.

Integrated care involves HCV screening and treatment with either DAA prescription directly in AM clinic or via telemedicine with an infectious diseases (ID) specialist. Using retrospective chart review, we assessed if the program affected rates of direct-acting antivirals (DAA) initiation, DAA completion, and sustained virological response (SVR).

Among 72 treatment naïve patients, the rate of DAA initiation increased after integrated care (HR 2.21, 95% CI 1.05-4.66), but rates of DAA completion or SVR did not significantly increase. Integrated care was associated with more DAA prescriptions (0.6 vs. 0 prescriptions per month, p = .004) and decreased referrals to hepatology (0.2 vs. 1 referrals per month, p = .001). Compared to referring patients to hepatology, prescribing DAAs in AM clinic was associated with higher rates of DAA initiation (HR 42.46; 95% CI: 15.25-118.24) and completion (HR 8.33; 95% CI: 2.76-25.16).

An integrated care program that involved both in-person and telemedicine options improve access to DAA therapy. Enhancing interprofessional collaboration and expanding telemedicine services offers a practical model for strengthening HCV care delivery.

This study demonstrates a practical approach to integrating HCV care into addiction treatment through development of inter-professional collaboration between healthcare specialties.