Hepatitis C treatment uptake in Australia is low. To
increase access to hepatitis C virus treatment for people who inject drugs, we
developed a community-based, nurse-led service that linked a viral hepatitis
service in a tertiary hospital to primary care clinics, and resulted in
hepatitis C treatment provision in the community.
A retrospective cohort study of patients referred to the
community hepatitis service was undertaken to determine the cascade of care.
Logistic regression analyses were used to identify predictors of hepatitis C
treatment uptake.
Four hundred and sixty-two patients were referred to the
community hepatitis service; 344 attended. Among the 279 attendees with
confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124
(48%) injected in the last month. Of 201 (72%) patients who had their fibrosis
staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C
treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis.
Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3
patients eligible for assessment achieved a sustained virologic response.
Advanced fibrosis was a significant predictor of treatment uptake in adjusted
analysis (AOR 2.56, CI 1.30–5.00, p = 0.006).
Our community hepatitis service produced relatively high
rates of fibrosis assessment, hepatitis C treatment uptake and cure, among
people who inject drugs. These findings highlight the potential benefits of
providing community-based hepatitis C care to people who inject drugs in
Australia–benefits that should be realised as direct-acting antiviral agents
become available.
Below: HCV Cascade of care in Australia
Full article at: http://goo.gl/FW9kYs
By:
Amanda J. Wade, Joseph S. Doyle, Margaret E. Hellard
Centre for Population Health,
Burnet Institute, Melbourne, Victoria, Australia
Amanda J. Wade, Margaret E. Hellard
School of Public Health and
Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria,
Australia
Diana M. Macdonald, Joseph S. Doyle, Margaret E. Hellard
Department of Infectious
Diseases, The Alfred, Melbourne, Victoria, Australia
Alexander J. Thompson
Department of Gastroenterology,
St Vincent’s Hospital, Melbourne, Victoria, Australia
Adam Gordon, Stuart K. Roberts
Department of Gastroenterology,
The Alfred, Melbourne, Victoria, Australia
Stuart K. Roberts, Alexander J. Thompson
Department of Medicine, Monash
University, Melbourne, Victoria, Australia
Joseph S. Doyle
Department of Medicine, The
University of Melbourne, Melbourne, Victoria, Australia
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