Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Transmission among Injecting Drug Users

Abstract

BackgroundInjecting drug users (IDUs) are a major and most important risk factor for rising hepatitis C virus (HCV) prevalence in Iran.ObjectivesThe objective of this study was to determine the effectiveness of methadone maintenance treatment (MMT) in prevention of HCV infection transmission among IDUs.Patients and MethodsA mathematical modeling has been used to estimate number of HCV infections averted. The input parameters used in the model were collected by self-reported method from 259 IDUs before registering and one year after MMT. Nonparametric statistical tests have been used to compare risky injecting and sexual behaviors among IDUs before and after participating in MMT program. Deterministic sensitivity analyses were done to show the effects of parameters’ uncertainty on outcome.ResultsOf the 259 participants, 98.4% (255) were men, the mean age ± SD was 33.1 ± 7.58 years and HCV prevalence was 50%. The studied IDUs reported lower rate of risky injecting and sexual behavior after participation in MMT program. The cumulative incidence of HCV per 100 IDUs due to sharing injection and unsafe sexual contact with MMT program were 13.84 (95% CI: 6.17 -21.51), 0.0003 (0.0001 - 0.0005) and without it 36.48 (25.84 - 47.11) and 0.0004 (0.0002-0.0006) respectively.ConclusionsThe MMT program is an effective intervention to prevent HCV infection transmission, although it is essential to compare its effectiveness with other interventions before implementing it in nationwide.

The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users

“…Although high rates of HCV among drug users have been reported previously , the literature investigating the effect of MMT on HCV incidence in this patient population is scarce. While MMT use has been shown to decrease self‐reported high‐risk behaviors associated with blood‐borne infection among this population, including frequency of heroin injection, needle or syringe sharing and unsafe sex , the evidence that MMT itself reduces HCV incidence has been mixed. As described above, a meta‐analysis published in 2011 was able to identify only eight studies which examined the impact of opioid replacement therapy on HCV incidence, with the overall effect not reaching statistical significance.…”

“…Hepatitis C virus (HCV) infection is a major global public health concern. Currently, more than 170 million people are infected and between 3–4 million new infections occur annually world‐wide . Chronic HCV infection manifests in a variety of ways , with the major burden of serious illness resulting from cirrhosis and hepatocellular carcinoma (HCC) .…”

Gender Differences Among Patients With Hepatitis C Virus Undergoing Rehabilitation Through Methadone Maintenance Treatment

“…About 70-80% of infected patients develop chronic infections, which lead to serious health problems [2][3][4]. Hepatitis C is very common in intravenous drug users in Iran [5,6] and HCV is a serious health concern among methadone patients in Iran [7]. A study of 539 injection opiate users in methadone treatment indicated that all of them were HCV-infected.…”

“…The study indicated that the rate of unsafe drug injection and high risk sexual behaviors were lower among the participants after receiving the treatment. Furthermore, methadone treatment was an effective intervention to reduce HCV transmission [7].…”

Advancing Service Integration in Opioid Treatment Progams for the Care and Treatment of Hepatitis C Infection

“…Others have utilized concurrent group treatment [73] and hepatitis care coordination [74] to address barriers to hepatitis C care and treatment. What is clear is that the provision of both methadone maintenance treatment and treatment for hepatitis C virus infection is important and such public health treatment approaches can reduce hepatitis virus infection and transmission globally in people who use drugs [75,76]. Thus, frameworks can be developed, as well as, national action plans to enhance the global efforts to provide hepatitis prevention, care and treatment to those in need [38,77].…”