This document summarizes a study that tested a collaborative, multidisciplinary model of care for treating hepatitis C in active drug users recruited from the community. 22 active drug users were enrolled and 16 completed evaluation to be eligible for treatment. 9 initiated antiviral therapy, with favorable tolerability and adherence. Responses to treatment have also been favorable, showing it is feasible to treat active drug users for hepatitis C using this integrated care model.

1. Hepatitis C Treatment Among Community-Recruited Active Drug Users: Establishing a Collaborative, Multidisciplinary Model of Care Michael R. Carden Brian R. Edlin Center for the Study of Hepatitis C Weill Medical College of Cornell University 6 th National Harm Reduction Conference Oakland, CA November 9, 2006

23. Treatment of Hepatitis C in Persons Actively Using Illicit Drugs Center for the Study of Hepatitis C, Weill Medical College, Cornell University Liver Biopsy: Fibrosis Stage (N=15) No. of participants

24. Treatment of Hepatitis C in Persons Actively Using Illicit Drugs: Current Outcomes Center for the Study of Hepatitis C, Weill Medical College, Cornell University Eligible for Treatment n = 16 Sample N = 30 RNA Negative n = 8 RNA Positive n = 22 Liver Biopsy n = 15 Decided Against Treatment n = 7 Initiated HCV Treatment n = 9 Relocated n = 2 Incarcerated n = 1 Head Injury n = 1 In Evaluation n = 2

27. Significant Depression Before and During Treatment By Peak Beck Depression Inventory (BDI) Scores Center for the Study of Hepatitis C, Weill Medical College, Cornell University Moderate Severe Before Treatment Severe Moderate At Treatment Initiation Severe Moderate On Treatment N=8 # of Participants Depression Category (Beck Depression Inventory) 0 0

28. Center for the Study of Hepatitis C, Weill Medical College, Cornell University Mean Depression Scores (BDI) Before and During Treatment Moderate Depression 19 28 * * * Multiple administrations per participant, approximately every 30 days (N=8)

29. Depression Scores (BDI) Before, During and After Treatment (N=8) Center for the Study of Hepatitis C, Weill Medical College, Cornell University BDI Score Weeks Moderate Depression Severe Depression Start Treatment Before and On Peg/Riba Off Peg/Riba

32. Center for the Study of Hepatitis C, Weill Medical College, Cornell University G1 G3 G1 G1 G1 G2 G1, Acute 0 8 16 20 24 28 32 21, W, F 35, L, M 50, W, M 45, AA, M 51, AA, F 36, W, F 19, L, F 33, L, M Participants (Age, Ethnicity, Gender) Weeks RVR = Rapid Virologic Response EVR = Early Virologic Response ETR = End of Treatment Response EVR EVR EVR RVR RVR RVR Interim Virologic Outcomes of Hepatitis C Treatment in Persons Actively Using Drugs (N=9) EVR 4 12 36 40 44 48 NR NR = No Virologic Response D/C D/C EVR RNA (-) RNA (-) RNA (-) RNA (+) RNA (+) ETR ETR G1 53, AA, M 24-week follow-up Peg/riba SVR SVR = Sustained Virologic Response Lost to f/ u ETR G3 EVR ETR ETR EVR SVR RNA (-) RNA (-)