(78) Under One Roof – An Integrated Clinic for SUD and HCV/HIV Treatment

Title: Under One Roof – An Integrated Clinic for Substance Use and HCV/HIV Treatment


Introduction: People with substance use disorders represent one of the highest risk populations for hepatitis C and HIV infections and yet currently face multiple obstacles to receiving treatment for these conditions. Integration of care, particularly in urban areas, has been shown to improve patient outcomes. In Maine, one of the most rural states in the nation, care is often fragmented due to transportation and other barriers. Our study objective was to assess the baseline characteristics and outcomes of patients with substance use disorder who receive combined substance use and hepatitis C/HIV treatment at a recently established “Bridge Program”. Embedded within an infectious disease clinic, patients received behavioral health support, medication for their substance use disorder if applicable, and treatment for their infection.

Methods: A retrospective chart review of patients enrolled in the Bridge program between 1/2020 – 11/2021 was conducted. A descriptive analysis of demographics, health characteristics, preventive services and treatment outcomes was performed.

Results: Of the 14 participants enrolled in the Bridge Clinic, 13 (93%) had hepatitis C, and 3 (21%) had HIV. In terms of demographics, five (36%) participants were homeless at the beginning of the Bridge Program as compared to 3 (21%) who were still experiencing homelessness by the end of this study. Six participants (43%) were previously incarcerated. In terms of health characteristics, 8 (57%) had mild liver disease, 3 (21%) had moderate liver disease, 1 (7%) had moderate to severe renal disease, 6 (43%) had chronic pain. Thirteen (93%) participants had a mental health diagnosis. Eleven (79%) participants had opioid use disorder, 6 (43%) had alcohol use disorder, 2 (14%) had stimulant use disorder, 3 (21%) polysubstance use disorder, 10 (71%) had active tobacco use disorder. Preventive services during the program included prescription of naloxone rescue kits (100% of patients with opioid use disorder), and hepatitis A and B vaccines (100% of participants received their initial vaccines and/or demonstrated immunity). Of patients with opioid use disorder, 11 (100%) were prescribed buprenorphine/naloxone during the program. The 3 participants with HIV received consistent antiretroviral therapy. Of the 13 participants with chronic hepatitis C, 12 (92%) were initiated onto hepatitis C antiviral treatment. 10 of those participants (83%) either successfully achieved sustained virologic response or are receiving ongoing treatment.

Conclusions Our study highlights the multiple, complex psychosocial and medical challenges (i.e., liver disease, mental illness, homelessness, incarceration) facing people with co-occurring substance use disorders and hepatitis C/HIV. It also demonstrates how an integrated clinic model, particularly in a rural state where care is often fragmented, can provide excellent comprehensive care including substance use disorder treatment, and naloxone prescribing, vaccinations and importantly, high rates of successful hepatitis C/HIV treatment.

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