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Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment

Lewis, Heather; Kunkel, Jan; Axten, David; Dalton, Jane; Gardner, Hayley; Tippett, Andrew; Wynne, Stephanie; Wilkinson, Mandie; Foster, Graham R.

European Journal of Gastroenterology & Hepatology: November 2016 - Volume 28 - Issue 11 - p 1258–1263
doi: 10.1097/MEG.0000000000000711
Original Articles: Hepatitis

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:

Received February 28, 2016

Accepted June 21, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.