S L I D E 0 Enhanced Uptake of Hepatitis C Treatment in an Opioid Treatment Program in the Direct Acting Antiviral Era Jenna Butner MD 1,2, Julia Shi MD 1, 2, Susan Henry RN CARN 2, Emily Tuozzo APRN 2, Chris Fabian LPN 2, Jeanette M. Tetrault MD 1,2 1 Yale University School of Medicine, CT, 2 APT Foundation, New Haven, CT

S L I D E 1 Disclosures None

S L I D E 2 Hepatitis C Treatment Challenges and Substance Use Disorders (SUDs) Malta M.AIDS Behav Edlin B, et al. Hepatology. Aug 2015 Denniston MM, et al. Ann Intern Med 2014 Ellwood M. Center for Health Law and Policy Innovation, Harvard Law School 2014 Grebely J. J Gastroenterol Hepatol Social stability and enrollment in SUD program Willingness to seek treatment Retention in treatment Financial aspect and insurance coverage Requirements (abstinence/sobriety duration) Comorbid psychiatric and medical conditions Risk of reinfection Presence of alcohol use disorders (AUDs) and Non-alcoholic steatohepatitis (NASH)

S L I D E 3 Persons At Elevated Risk of HCV Transmission hcvguidelines.org

S L I D E 4 HCV Treatment Models Standard model: referral to specialty care On-site HCV treatment in an opioid treatment program (OTP) is feasible and effective as has been demonstrated in other centers All oral based treatments, or Direct Acting Antivirals (DAAs), present new opportunities for HCV care delivery in OTPs Litwin AH, et al. Int J Drug Policy Oct;26(10) Stein M, et al. J Subst Abuse Treat Dec;43(4)

S L I D E 5 Objectives Illustrate elements of on-site treatment delivery in our OTP that promote favorable treatment outcomes Compare HCV treatment and substance use treatment outcomes among patients who initiated treatment in the IFN (Interferon) and DAA (Direct Acting Antiviral) eras

S L I D E 6 Methods Patients presenting to APT Foundation’s OTP undergo physical and psychiatric evaluations at the Central Medical Unit: HCV and HIV screening are offered HCV+ patients are offered confirmatory HCV RNA testing, further work-up and exploration of treatment options HCV and OTP treatment data was compared between the IFN ( ) and the DAA (2013-present) eras: Variables Measured End of Treatment Response (EOTR) Sustained Virologic Response (SVR) HCV Treatment Adherence Retention in OTP treatment Urine Drug Screen (UDS) Negative for Illicit Substances

S L I D E 7 Unique Elements of On-Site Treatment Provide HCV education to patients: –Review modes of transmission –Discuss chronology/evolution of HCV –Involve patient’s partner and family, and encourage screening for themselves Arrange frequent follow-up: –Distribution of medication at clinic in short duration and individualized packs –Utilize specialty pharmacy with medication delivery directly to clinic. Coordination of care with: –OTP clinician, social worker, psychiatrist

S L I D E 8 Patients Treated During IFN era (mid mid 2013) and DAA era (mid 2013-present) Number of Patients

S L I D E 9 Comparison of IFN to DAA Treated Patients (n= 60) %% % %

S L I D E 10 Conclusions and Future Directions The DAAs in combination with elements of on-site HCV treatment delivery in an OTP offer a unique approach to the care and education of all patients who have history of substance use disorder. Lowering rates of HCV in this population would be furthered by early detection, intervention, and maintenance in an OTP Data on the use and feasibility of novel DAA-based therapies among patients with SUD is limited and warrants further investigation Dimova R. Clin Infect Dis Litwin. J Subst Abuse Treat. 2009

S L I D E 11 Thank You