Transcript HCV Mono-Infection: Female, Lacks Housing

HCV Mono-Infection: Female,
Lacks Housing
Patricia Perkins, MS, MPH
Tri City Institute, LA, CA
CAB: OASIS, Oakland, CA
www.pperkins.org & www.oasisclinic.org
“Laura’s basic hx”
• Mixed race young female (now age 25) presents to
HIV and then HCV screening and testing studies
• Lack of housing, travel, and no regular phone
makes tracking complicated
• Heroin primary drug of use
• Injection primary means of use
• Client desires entry in routine drug tx and other
case management services
Clinical/Medical History
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Laura is documented HIV-, HCV+
Viral titer remains unknown until 10/01
Drug injector for 7 years
History of depression; responds well to SSRIs, no
suicide attempts
• Contraceptive practices uneven; counseling
needed here
• Desires to get on heroin detox or MMT; was in
buprenorphine research study in LA in late 1990s
Laura’s Work and Living
Situation
• Laura does “street survival”
• Laura occasionally works at Copy Center
• Is “couch surfer” with one or two male
sexual partners
• Recently was re-admitted to UC Berkeley;
has received a housing subsidy for 8/02
Drug/Alcohol Use History
• Heroin Use, with injection since 1996
• Alcohol use constant until 1999, when she
and male partner tested HCV+
• 3 episodes of heroin detox 1996-1998
• Buprenorphine clinical study 1998-1999
• Finally secured MMT treatment slot 8/01
Current Drug/Alcohol Profile
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MMT Patient for One Year
Clean UA’s since Oct. 01
Regular attendance at AA in two comm.
Primary male partner now in MMT & AA
Secondary partner, who provides housing
continues to use drugs/alcohol
Medical & Insurance Evaluation
• June 01 receives preliminary med eval at OASIS
clinic:
– CBC/Chem Panel - $10.00 (grant funds)
– HCV RNA (viral load) - $75.00 (local deal)
– Hep A/B vaccination through Berkeley NEED (local
SEP and Berkeley Free Clinic: (state/local funding)
– Liver biopsy (as part of UC Study) $1500 (covered as
part of UCSF HCV/Alcohol study)
– Final receipt of MediCal managed care: May 2002: 8
months after completion of application and 2 denials
How would you rank Laura’s likelihood
for HCV treatment success?
• Client continued to attend OASIS weekly
treatment education and support groups for 4
months prior to getting biopsy
• Upon completion of 4 clean UA’s in MMT
initiating 3/times weekly IFN & ribavirin
• Requests Rx for SSRI month 2 of Tx
• At month 4 of Tx, needs EPO infusion
• At month 6 of Tx, tests virus free
• Currently, Month 8 of Tx, doing well, anxious to
return to education and serve at treatment advocate
Are there “Lauras” in Your
Community Settings?
• Other Resources in Phoenix:
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Medical
Psycho-social
Free/low cost vaccine
Drug treatment, subsidized slots
Development of support groups with harm
reduction/SEP/drug tx settings
Acknowledgements
• “Laura” and her family
• OASIS medical team: Dr. Sylvestre & Barry
Clements, PA.c
• Board & CAB at OASIS
• Dr. Norah Terrault and staff at UCSF
• Our funders for HCV treatment protocol:
Schering Oncology Biotech