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European Journal of Gastroenterology & Hepatology:
doi: 10.1097/MEG.0000000000000150
Original Articles: Hepatitis

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

Baker, Davida,b; Alavi, Maryamc; Erratt, Amandac; Hill, Sonjaa; Balcomb, Anniee; Hallinan, Richardd; Siriragavan, Sharmilac; Richmond, Davidf; Smart, Johng; Keats, Julianh; Doong, Nicholasi; Marks, Pipc; Grebely, Jasonc; Dore, Gregory J.c

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Abstract

Objectives: The aim of this study was to evaluate the feasibility, safety and efficacy of treatment for chronic hepatitis C virus (HCV) infection through a primary care-based model for the delivery of HCV services in New South Wales (NSW), Australia.

Participants and methods: This observational cohort study recruited participants through seven primary care clinics in NSW, Australia, between November 2010 and June 2013. Patients with HCV genotype 2/3 were treated without specialist review, whereas those with genotype 1 required an initial specialist review. Treatment consisted of pegylated interferon-α-2a/2b and ribavirin. Sustained virological response and adverse events were evaluated.

Results: Among 41 participants (mean age 44 years, 73% men) initiating treatment with pegylated interferon-α-2a/2b and ribavirin, 90% had injected drugs ever, 16% had injected drugs in the past 30 days and 56% had ever received opioid substitution treatment. HCV genotype 1 and genotype 2/3 occurred in 17% (n=7) and 83% (n=34). Treatment was completed in 83% (34 of 41), with seven discontinuations [adverse event (depression), n=1; patient decision, n=1; lost to follow-up, n=3; virological nonresponse, n=2]. In an intent-to-treat analysis, sustained virological response was 71% overall (29 of 41), 43% in genotype 1 (three of seven) and 76% in genotype 2/3 (26 of 34).

Conclusion: 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.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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