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
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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: firstname.lastname@example.org
Received April 5, 2014
Accepted May 29, 2014