909. Treating Hepatitis C Virus (HCV) in Young Adult Active Drug Users Is Possible

Background Successful treatment of HCV in persons who inject drugs (PWIDS), has been reported for patients who were older or who had used drugs more than 6 months prior. The young, < 35 year of age (yoa), active user has not been well studied or reported. We performed a pilot treatment study in a young cohort of PWIDS to evaluate cure rates of HCV in this population. Methods Young, active PWIDS using < 6months earlier, < 35 yoa were identified. Treatment for HCV with glecaprevir/pibrentasvir (G/P) and concurrent treatment for opiate use disorder with XR Naletrexone (XR-NTX) was provided. Two patients chose methadone. Patients were followed up to 12 months after enrollment. Patients were evaluated for adherence, side effects, alanine aminotransferase (ALT) levels, urine drug screens (UDS) and opioid craving scores using a visual analog scale (VAS) while on XR-NTX to assess management of their addiction. Rates of treatment completion, SVR 4 & 12 were determined. Results 30 patients were recruited: 18 were women. Average age was 28 with a range of 23-35. Recent injection drug use was common with 22 (73%) having injected within the 30 days and all having injected within 3 months of recruitment. The average ALT on enrollment was 106. Genotypes were 1 (15), 3a (11), and unknown (4). Of the 30 patients, 15 failed to come for the required 2 visits prior to starting G/P. Lost to follow up occurred due to relapse of addiction (9), overdose death (1), lost communication and suspected relapse (4). 15 began and completed G/P. 15 were cured of their HCV infection. 17 patients receive one or more doses of XR-NTX. On average patients were on XR-NTX for 4.8 months. Sobriety was measured for patients on XR-NTX using Opiate Craving Scores using the Visual Analogue Scale (VAS) and UDS (Figure 1) demonstrating excellent control of craving and significant declines positive UDS. Toxicities were uncommon with no treatment limiting adverse events. Adverse effects of XR-NTX included mild injection site irritation. No ALT abnormalities were noted. Conclusion Young active PWIDS can successfully be cured of HCV. Their addiction can be concurrently managed with XR-NXT. Our findings suggest it is safe to treatment active users with active HCV with XR-NXT improving elimination goals. Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau) Kathleen H. Seneca, MSN, Abbvie (Research Grant or Support)Alkermes (Research Grant or Support)Gilead (Speaker’s Bureau) Ruth A. Homer, MSW, Abbvie (Grant/Research Support)Alkermes (Grant/Research Support)

Assessment of the Effectiveness of Matrix Model Among Methadone Patients Using ATS in Ho Chi Minh City, Vietnam

This study assessed the effectiveness of the application of the Matrix model in patients undergoing methadone treatment for Amphetamine-type substance (ATS) in Ho Chi Minh City. A total of 951 methadone patients were screened; 60 (16%) met the inclusion criteria and of those 51 (85%) completed 16 weeks of study procedures. Most of the participants were ATS users with moderate or higher risk of dependence. Compared to the non-intervention group, the intervention group showed a significant reduction in positive urine tests for methamphetamine (a decrease from 100% to 11% vs. a decrease from 100% to 98% for the non-intervention group, p<0.001) and for opiates (a decrease from 36.7% to 3.7% vs. a decrease from 43.3% to 29.2% for the non-intervention group). In the intervention group, the quality of life increased from 76.74 points to 85.5, the proportion of depression decreased from 43.3% to 18.5%, anxiety decreased from 30% to 11.1%, and stress decreased from 76.7% to 29.6%. In the non-intervention group, quality of life decreased from 75.2 points to 74.5 points, the proportion of depression decreased slightly from 40% to 36%, anxiety decreased from 33.3% to 24%, and stress decreased from 76.7% to 76.0%. The intervention group was significantly more likely to adhere to methadone treatment (p<0.001). The proportions of participants in the intervention group and non-intervention group who discontinued treatment were 10% and 20%, respectively. The study results suggested that the MATRIX model could help reduce ATS and opiate use and improve mental health as well as treatment adherence.

TAILORING EVIDENCE-BASED INTERVENTIONS TO REDUCE METHAMPHETAMINE USE AMONG HIV-POSITIVE PATIENTS ON METHADONE IN HO CHI MINH, VIETNAM

This study evaluated the effectiveness of evidence-based intervention to reduce methamphetamine (MET) use among HIV-positive users in Ho Chi Minh. A total of 236 HIV-positive patients were screened, 71 (30.1%) met the inclusion criteria and 51 (71.8%) were enrolled. Of those enrolled, 49 completed 12 weeks of the intervention, most (?%) of whom used amphetamine-type substances at moderate or higher risk of dependence. The intervention reduced the rate of positive urine MET tests from 54.9% to 12.5%. Participants at intermediate risk for MET (93.1%) were significantly more likely to respond to positive behavior management during the first 6 weeks than participants at high-risk (6.9%, p=0.01). The responder group with positive behavioral management (n=29, 56.8%) received phone/SMS intervention during the latter six weeks of the study and were able to maintain negative urine drug tests. In the non-responder group (n=20), there was no significant difference between the group receiving the Matrix intervention and the group receiving the Matrix intervention in combination with positive behavior management. At the end of the study, 31% of responders and 35% of non-responders had viral loads below the detectable threshold. The results of the study suggest that an evidence-based intervention can reduce the MET use among HIV-positive methadone patients. More studies with larger sample size are needed to better evaluate the effectiveness of interventions as well as their feasibility for widespread adoption.

Medication Assisted Recovery Support (MARS): An effective model to facilitate the recovery process for Methadone patients in Hoa Binh and Thai Nguyen provinces

This qualitative study aims to assess the Medication Assisted Recovery Support (MARS) program on the recovery process for Methadone patients in Hoa Binh and Thai Nguyen provinces to provide a clear insight on its effectiveness, impact and sustainability. Two focus group discussions were conducted with 40 people including patients of the two Methadone treatment clinics and peer-led club members and 18 semi-structure interviews were carried out with health staff, peer leaders and patient family members, in Hoa Binh and Thai Nguyen in July-August 2017. The discussions and interviews were taped, transcribed and analyzed. The patients found that peer support clubs are very effective. They perceived more respects from families and neighbors. Family trust and support are important for the patients’ treatment adherence. Home income generation and job are the most concerns. The MARS has improved the patients’ knowledge about drug addiction and the importance of the Methadone treatment. It helps to change the patients’ behavior and practices on treatment adherence. It is necessary to support drug users to find jobs and implement social policies to provide loans for them to be financially stable and improve effectiveness of the Methadone treatment.

Evidence for the transfer of methadone and EDDP by sweat to children’s hair

In cases where there is a question as to whether children have come into contact with drugs, examinations of their scalp hair are frequently carried out. Positive test results are often discussed in the forensic community due to the various possible modes via which drugs and their metabolites can be incorporated into the hair. These include drug uptake by the child (e.g. oral ingestion or inhalation), but also contamination of hair via contact with the sweat from drug users. In this study, the possibility of methadone and its metabolite EDDP being incorporated into children’s hair by contact with sweat from persons undergoing opiate maintenance therapy (methadone) was examined. The transfer of methadone and EDDP via sweat from methadone patients (n = 15) to children’s hair was simulated by close skin contact of drug-free children’s hair, encased in mesh-pouches, for 5 days. Sweat-collecting patches (hereafter referred to as ‘sweat patches’) were applied to the test persons’ skin. One strand of hair and one sweat patch were collected daily from each patient. Analyses were performed using GC–MS/MS (hair) and LC–MS/MS (serum, sweat patches). After 4 days of skin contact, methadone was detectable in the formerly drug-free hair strands in all 15 study participants. EDDP was detectable in 34 of 75 hair strands, with the maximum number of positive results (11 EDDP-positive hair strands) being detected after 5 days. These results show that transfer of methadone and EDDP to drug-free hair is possible through close skin contact with individuals taking part in methadone substitution programmes. A correlation between serum concentration, sweat concentration and substance concentration in hair strands could not be demonstrated, but a tendency towards higher concentrations due to longer contact time is clearly evident.