Delivery of treatment for hepatitis C virus infection in the primary care setting

Baker, David; Alavi, Maryam; Erratt, Amanda; Hill, Sonja; Balcomb, Annie C.; Hallinan, Richard; Siriragavan, Sharmila; Richmond, David; Smart, John; Keats, Julian; Doong, Nicholas; Marks, Pip; Grebely, Jason; Dore, Gregory J.

doi:10.1097/meg.0000000000000150

Cited by 16 publications

(13 citation statements)

References 15 publications

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“…HCV treatment in primary care has been shown to be effective in the pre-DAA era and there are substantial advantages to patients in terms of treatment occurring nearer to the patient’s home and being supervised by a practitioner who is familiar to them 15. Our data confirm that treatment in primary care is associated with excellent SVR rates.…”

Section: Discussionsupporting

confidence: 71%

Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

White

Azzam

Burrage

et al. 2018

Frontline Gastroenterol

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BackgroundAustralia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care.ObjectivesIn order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland.DesignRetrospective analysis of a prospectively recorded HCV treatment database.InterventionsA nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care.Results327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38–56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%.ConclusionCommunity-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

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Section: Discussionsupporting

confidence: 71%

Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

White

Azzam

Burrage

et al. 2018

Frontline Gastroenterol

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“…The other criteria (standard criteria for measuring the condition, valid and reliable way for measuring the outcomes and appropriate statistical analysis) were met by all studies. Sixteen studies fulfilled all the eight criteria …”

Section: Resultsmentioning

confidence: 99%

“…Rapid virological, early virological and end of treatment responses are comparable for community based and tertiary models. Based on the reviewed studies, at least 62% and 75% of patients achieved RVR and EVR, respectively . In a meta‐analysis, RVR of about 31% and EVR of about 68% were reported for patients who received Peg‐IFN plus RBV .…”

Section: Discussionmentioning

confidence: 99%

“…Sixteen studies fulfilled all the eight criteria. [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] There were three cohort studies-in one study, there was a subgroup analysis with significant differences in some baseline characteristics between the two groups. 55 In one study, it was not clear how the exposure (receiving treatment at community settings) was measured.…”

Section: Quantitative Studiesmentioning

confidence: 99%

“…17-19,22,23,27,28,30,31,33,36-39,41,43,45,46,48-50,52,54,58-60,62-64 (c) Integration of HCV and HIV services where HCV services were added to existing HIV programmes in a primary care clinic and a multidisciplinary team including an on-site hepatologist provide HCV care. 35 (d) Integration of HCV and primary care models where HCV services was provided in settings where patients received routine primary care, 12,21,24,25,29,34,40,42,47,51,53,61 and (e) home care and health care management company models where HCV treatment was provided by a home care nurse in collaboration with a hospital liver clinic or a care management nurse supervised by a multidisciplinary committee in a care management company. 20,26 Most of the models were physician-led, but in some of the models, nurse practitioners or nurses were programme coordinators.…”

Section: Describing the Models Of Carementioning

confidence: 99%

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Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Pourmarzi

Hall

Hepworth

et al. 2019

Journal of Viral Hepatitis

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Summary Several community‐based models for treating hepatitis C virus (HCV) infection have been implemented to improve treatment accessibility and health outcomes. However, there is a lack of knowledge regarding how well these models achieve the desired goals. We conducted a mixed‐method systematic review of quantitative and qualitative evidence about clinical effectiveness, cost effectiveness and acceptability of community‐based HCV treatment models. Seventeen databases were researched for published and unpublished studies. Methodological quality was assessed using The Joanna Briggs Institute Critical Appraisal tools. Quantitative findings were synthesized in narrative form and qualitative findings were synthesized using meta‐synthesis. Forty‐two quantitative and six qualitative studies were included. No relevant cost effectiveness studies were found. Five categories of community‐based models were identified: telehealth, integration of HCV and addiction services, integration of HCV and HIV services, integration of HCV and primary care, and implementation by a home care and health care management company. The range of reported outcomes included; end of treatment response: 48.7% to 96%, serious side effects: 3.3% to 27.8%, sustained virological response: 22.3% to 95.5%, relapse: 2.2% to 16.7%, and treatment completion: 33.4% to 100%. Inconsistent measures of uptake and adherence were used; uptake ranged from 8.3% to 92%, and 68.4% to 100% of patients received ≥80% of prescribed doses. Patient reported experiences included trusted and supportive care providers, safe and trusted services, easily accessible care, and positive psychological and behavioural changes. The clinical effectiveness and acceptability reported from the included studies are similar to or better than reported outcomes from systematic reviews of studies in tertiary settings. Studies of the cost effectiveness of community‐based models for treating HCV are needed.

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Cure and Control: What Will It Take to Eliminate HCV?

Martinello

Hajarizadeh

Grebely

et al. 2019

Topics in Medicinal Chemistry

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Delivery of treatment for hepatitis C virus infection in the primary care setting

Abstract: Initiation of HCV treatment in the primary care setting is an effective alternative for selected patients and may contribute towards increasing access to HCV care.

Cited by 16 publications

References 15 publications

Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Cure and Control: What Will It Take to Eliminate HCV?

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