Background: Chronic hepatitis C is common in people who inject drugs (PWID) and this population serves as a reservoir for infection. Treatment levels are low among this group, ranging from 1 to 19%. We explored whether a nurse-initiated community treatment model increased uptake of and adherence to interferon-based therapies.
Methods: This was a cluster randomized trial of nurse-initiated versus physician-initiated antiviral therapy with pegylated interferon and ribavirin for hepatitis C virus in community clinics (trial registration: ISRCTN07774040).
Results: The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each arm not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy.
Conclusion: Despite easy access to antiviral therapy, uptake of treatment was poor, with no significant difference between the groups. Nurse-led initiation of interferon-based antiviral therapy in PWID did not lead to increased uptake of, response to or adherence with treatment. Further service improvement is unlikely to increase the proportion of PWID undergoing antiviral therapy for hepatitis C virus and early adoption of interferon-free regimens may increase the proportion initiating and completing treatment.
aDepartment of Gastroenterology, Frimley Health Foundation Trust, Surrey
bHepatology Unit, Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London
cBlood Borne Virus Team, Tower Hamlets Specialist Addiction Unit, East London NHS Foundation Trust, Beaumont House, Mile End Hospital, London, UK
* Heather Lewis and Jan Kunkel contributed equally to this article.
Correspondence to Heather Lewis, MBChB, MRCP, MD(Res), Department of Gastroenterology, Frimley Health Foundation Trust, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK Tel: +44 796 755 1567; e-mail: email@example.com
Received February 28, 2016
Accepted June 21, 2016