Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

Abstract

BackgroundAustralia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care.ObjectivesIn order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland.DesignRetrospective analysis of a prospectively recorded HCV treatment database.InterventionsA nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care.Results327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38–56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%.ConclusionCommunity-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

An Investigation of the Side Effects, Patient Feedback, and Physiological Changes Associated with Direct-Acting Antiviral Therapy for Hepatitis C

“…The rate of SVR achieved in our study was higher than that in a study in Australia by White et al, who enrolled 327 patients who underwent assessment and commenced treatment in primary care settings with an SVR rate of 95.6% [19]. Moreover, the medication adherence was also higher in this study than that in a study conducted in a psychiatry department in Sweden by Sundberg et al, who showed that adherence to DAA treatment was estimated at 95%, and the SVR rate was 88% [23].…”

“…The present study showed that most of the participants were older, female, of low social economic status, had undergone 12 weeks of treatment, and were predominantly infected with the viral genotypes 1b and 2. With the exception of the age and sex of our cohort, much of the demographic characteristics were similar to those of cohorts studied in Japan and Australia [13,18,19]. For instance, in Australia, White et al found that the median age of patients was 48 years, 66% of participants were male, 26% had been previously treated with eight-week regimens, and 57% tested positive with genotype 1 [19].…”

“…With the exception of the age and sex of our cohort, much of the demographic characteristics were similar to those of cohorts studied in Japan and Australia [13,18,19]. For instance, in Australia, White et al found that the median age of patients was 48 years, 66% of participants were male, 26% had been previously treated with eight-week regimens, and 57% tested positive with genotype 1 [19]. In South Korea, HCV patients had a mean age of 57.3 years, and the major genotypes detected were 1b (48.2%) and 2 (46.4%) [20].…”

Overcoming barriers to hepatitis C elimination

“…In this issue of Frontline Gastroenterology , the group of Prof. O’Beirne from the University of the Sunshine Coast in Australia developed an interesting and successful HCV model of care addressing the challenge of providing treatment to patients in remote areas 8. Australia is a vast country with a strong political commitment in achieving WHO goal of HCV elimination.…”

The ECHO model proved to be a useful tool to increase clinicians' self‐effectiveness for care of patients with Hepatitis C in Argentina

“…Several successful training programmes of partial task shifting‐shared treatment between primary care providers and specialists demonstrated improved access to HCV care and equivalent sustained virologic response (SVR) rates . One of these initiatives is called Project ECHO (Extension for Community Healthcare Outcomes), a tele‐mentoring programme originally launched at the University of New Mexico .…”