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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

European Journal of Gastroenterology & Hepatology: September 2014 - Volume 26 - Issue 9 - p 1003–1009
doi: 10.1097/MEG.0000000000000150
Original Articles: Hepatitis

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.

aThe Australasian Society for HIV Medicine (ASHM)

bEast Sydney Doctors

cThe Kirby Institute, UNSW Australia

dThe Byrne Surgery, Sydney

eClinic 96, Orange

fCowra Medical Associates, Cowra

gAsquith Medical Centre, Asquith

hHunter Pharmacotherapy, Newcastle

iDr Doong’s Clinic, Burwood, New South Wales, Australia

All supplementary digital content is available directly from the corresponding author.

Correspondence to Gregory J. Dore, BSc, MBBS, MPH, PhD, Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia Tel: +61 2 9385 0900; fax: +61 2 9385 0876; e-mail: gdore@kirby.unsw.edu.au

Received April 5, 2014

Accepted May 29, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins