Improving access to direct acting antivirals via a multimodal integrated care program in an addiction medicine clinic

Arya Zandvakili; Joseph Rattenni; James Burton; Lakshmi Guduguntla; Marcus Osman; Sayeh Sabbagh; Stephan Arndt; Ben Miskle; Quanhathai Kaewpoowat; Michael Ohl; Andrea Weber; Alison Lynch

doi:10.1111/ajad.70155

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Improving access to direct acting antivirals via a multimodal integrated care program in an addiction medicine clinic

Journal article

Open access

Peer reviewed

Improving access to direct acting antivirals via a multimodal integrated care program in an addiction medicine clinic

Arya Zandvakili, Joseph Rattenni, James Burton, Lakshmi Guduguntla, Marcus Osman, Sayeh Sabbagh, Stephan Arndt, Ben Miskle, Quanhathai Kaewpoowat, Michael Ohl, …

The American journal on addictions

03/12/2026

DOI: 10.1111/ajad.70155

PMID: 41818284

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Abstract

Background and Objectives Injection drug use is a driver of hepatitis C virus (HCV) transmission, thus integrating HCV care into addiction care is likely necessary for HCV elimination. Here we describe how we integrated HCV care into our addiction medicine (AM) clinic and evaluate its effect on HCV treatment.Methods Integrated care involves HCV screening and treatment with either DAA prescription directly in AM clinic or via telemedicine with an infectious diseases (ID) specialist. Using retrospective chart review, we assessed if the program affected rates of direct-acting antivirals (DAA) initiation, DAA completion, and sustained virological response (SVR).Results Among 72 treatment na & iuml;ve patients, the rate of DAA initiation increased after integrated care (HR 2.21, 95% CI 1.05-4.66), but rates of DAA completion or SVR did not significantly increase. Integrated care was associated with more DAA prescriptions (0.6 vs. 0 prescriptions per month, p = .004) and decreased referrals to hepatology (0.2 vs. 1 referrals per month, p = .001). Compared to referring patients to hepatology, prescribing DAAs in AM clinic was associated with higher rates of DAA initiation (HR 42.46; 95% CI: 15.25-118.24) and completion (HR 8.33; 95% CI: 2.76-25.16).Discussion and Conclusions An integrated care program that involved both in-person and telemedicine options improve access to DAA therapy. Enhancing interprofessional collaboration and expanding telemedicine services offers a practical model for strengthening HCV care delivery.Scientific Significance This study demonstrates a practical approach to integrating HCV care into addiction treatment through development of inter-professional collaboration between healthcare specialties.

Substance Abuse

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: Improving access to direct acting antivirals via a multimodal integrated care program in an addiction medicine clinic
Creators: Arya Zandvakili - University of Iowa
Joseph Rattenni - University of Iowa
James Burton - University of Iowa
Lakshmi Guduguntla - University of Iowa
Marcus Osman - University of Iowa
Sayeh Sabbagh - University of Iowa
Stephan Arndt - University of Iowa
Ben Miskle - University of Iowa
Quanhathai Kaewpoowat - University of Iowa
Michael Ohl - University of Iowa
Andrea Weber - University of Iowa
Alison Lynch - University of Iowa
Resource Type: Journal article
Publication Details: The American journal on addictions
DOI: 10.1111/ajad.70155
PMID: 41818284
NLM abbreviation: Am J Addict
ISSN: 1055-0496
eISSN: 1521-0391
Publisher: Wiley
Number of pages: 9
Grant note: 5883AP45 / Iowa Department of Public Health
Language: English
Electronic publication date: 03/12/2026
Academic Unit: Psychiatry; Biostatistics; Addiction Medicine; Family and Community Medicine; Nursing; Pharmacy Practice and Science; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9985147206202771

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