F/C AETC FacultyHIV HCV

Thursday, March 12, 2015 | 1:30pm EDT

Medical Facilitator/Didactic Presenter

Todd S. Wills, MD

University of South Florida

Case Discussant

Elizabeth Sherman, PharmD, AAHIVP

Nova South Eastern University

Maribel Gonzalez, MSN, ARNP-C

University of South Florida

Suzanne Stevens, MSW

University of South Florida

Managing Addiction in HCV PatientsTodd Wills, MD

Associate Professor

Infectious Disease and International Medicine

University of South Florida

F/C AETC FacultyAdapted from: Sulkowski, et al. A Guide for Evaluation and Treatment of Hepatitis C in Adults Coinfected with HIV. DHHS (HRSA) 2011 Unless otherwise noted

Assessment of Alcohol and Substance Abuse

• Ongoing Alcohol use? Amount?• Ongoing Substance Abuse? Amount?• How much use is acceptable?• What are individual clinic protocols?

Evaluating and Modifying Obesity

• Obesity is associated with nonalcoholic fatty liver disease and steatosis

• Insulin resistance may diminish response to interferon

• What is the weight criteria for treatment initiation?

• What are individual clinic protocols?

Overcoming Barriers to Treatment Initiation

• Substance Abuse Counselors• Opioid Dependence Treatment• Patient Education• Peer-Based Counseling• Group Counseling• Clinic Based Injections• Any other specific clinic strategies?

Opioid Dependence Treatment

• methadone maintenance treatment• diminishes and often eliminate opioid use

• buprenorphine• office-based pharmacotherapy for opioid

addiction• physicians who complete a defined training can

apply for a waiver to the Drug Addiction Treatment Act of 2000

National Institutes of Health Effective medical treatment of opiate addiction. NIH Consensus Statement 1997;15(6):1-38. Available at:http://odp.od.nih.gov/consensus/cons/108/108_intro.htm

Center for Substance Abuse Treatment Buprenorphine physician training events. Rockville, MD: Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services; Available at:http://buprenorphine.samhsa.gov/training.html

Alcohol Use Intervention

• Brief interventions by medical providers focused on problem use of alcohol• client-centered counseling• reflective listening • nonjudgmental demeanor

• Core elements include:• assessing current levels of consumption• providing education regarding risks • assessing and facilitating motivation to alter

alcohol consumptionBhattacharya R, Shuhart MC Hepatitis C and alcohol: interactions, outcomes and implications. J Clin Gastroenterol 2003;36:242-52

Primary care Intervention

Primary Care Intervention

• toxicological and questionnaire screening

• brief motivational interviews• active referrals• a list of treatment providers• follow-up booster phone call.

Patient Support Services

• Providing essential support services helps improve patient retention:• case management• transportation• housing for the homeless

Sherer R, Stieglitz K, Narra J, et al. HIV multidisciplinary teams work: support services improve access to and retention in HIV primary care. AIDS Care2002;14(Suppl 1):31-44.

Patient Support Services

•  Specialized tools to improve adherence:• electronic reminder system• directly observed therapy• cash incentives for attending scheduled

medical appointmentsLorvick J, Edlin BR Program and abstracts of the 128th annual meeting of the American Public Health Association (Boston). Washington, DC: American Public Health Association; 2000. Effectiveness of incentives in health interventions: what do we know from the literature?

Jani AA, Bishai WR, Cohn SE, et al American Public Health Association and Health Resources and Services Administration. 2004. Adherence to HIV treatment regimens: recommendations for best practices. Available at:http://www.apha.org/ppp/hiv/Best_Practices_new.pdf

http://www.motivationalinterview.org/

http://pubs.niaaa.nih.gov/publications/MATCHSeries3/Project MATCH

Questions & Answers