Hepatitis C cascade of care at an integrated community facility for people who inject drugs

Morris, Leith; Williams, Owain David; Gilks, Charles F.; Kvassy, Amanda; Smirnov, Andrew

doi:10.1016/j.jsat.2020.108025

Cited by 14 publications

(19 citation statements)

References 25 publications

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“…24,25 The proportion of people commencing treatment (74%) was similar to a study from four sites that are part of the Queensland Injectors Network where 72% of people commenced treatment. 26 Like our findings, amongst people who had an SVR test, 97% were cured. Treatment outcomes were comparable to or better than HCV nurse-coordinated and/or nurse-led services in studies from other high-income countries.…”

Section: Discussionsupporting

confidence: 79%

“…Although a large number of people who were known to be homeless or unstably housed commenced treatment, this group were less likely to commence treatment compared to people who were stably housed. This is reflective of other Australian studies in harm reduction settings 26,29 and consistent with low treatment uptake in dedicated homeless services in Australia, 18,31 Iran 32 and the United States 28 . In the absence of stable housing, people often face a range of health and social concerns and may prioritize more immediate needs.…”

Section: Discussionsupporting

confidence: 73%

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A multi‐site, nurse‐coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia

Harney

Whitton

Paige

et al. 2021

Liver International

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Background: Hepatitis C virus (HCV) treatment through primary care and communitybased services will be a critical component of HCV elimination. We evaluated a nursecoordinated programme providing care across eight sites and analysed progression through the HCV care cascade.Methods: People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow-up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. Results:Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive.Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48-4.88). People who were homeless/unstably housed

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 73%

A multi‐site, nurse‐coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia

Harney

Whitton

Paige

et al. 2021

Liver International

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“…We financially incentivized study enrollment but intentionally did not incentivize engagement with study visits, medication pickups, or SVR12 lab results. The SSP group also had a higher rate of homelessness and other factors previously associated with lower SVR12 rates, especially in ITT analysis, driven by completion of lab results (18)(19)(20). Our data did not show homelessness to be negatively associated with SVR12, though it was inadequately powered for this association and other data our group has published has found lower SVR12 completion among homeless individuals (21).…”

Section: Discussioncontrasting

confidence: 66%

Hepatitis C Treatment Among People Who Use Drugs in an Office-Based Opioid Treatment Program Versus a Syringe Exchange Program: A Real-World Prospective Clinical Trial

et al. 2021

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Background: Hepatitis C Virus (HCV) treatment in people who inject drugs (PWID) is a key component of elimination models but PWID face substantial barriers to treatment access. Despite data showing treatment outcomes among PWID on medications for opioid use disorder (MOUD) are similar to non-PWID outcomes, few studies examine PWID treatment outcomes with only syringe services support. Objectives: To evaluate the effect of recruitment for HCV treatment with elbasvir/grazoprevir (E/G) in a syringe services program (SSP) as compared to an MOUD program for people with opioid use disorder. Methods: This real-world, multi-site prospective open-label pilot study compares treatment of PWID with aspartate aminotransferase to platelet ratio (APRI) < 0.7 and genotype 1a, 1b, and 4 HCV with E/G, engaged in MOUD (n = 25) or an SSP (n = 25). The MOUD arm was enrolled through a federally qualified community health center and SSP arm through a nearby SSP. Prospective arms were compared to an academic hepatology clinic group (n = 50). Sustained virologic response at 12 weeks (SVR12), medication adherence, and treatment discontinuation were evaluated. Results: In the MOUD vs SSP arms, substance use throughout treatment was found in 36% (9/25) vs 100% (25/25); good adherence (> 90% pills taken) in 100% (25/25) vs 68% (17/25); treatment completion 100% (25/25) vs 64% (16/25); and SVR12 rates were 96% (24/25) vs 60% (15/25). In the community standard comparison group, SVR12 was achieved in 94% (47/50). There were two virologic failures or re-infections in the SSP group; all other non-responders were due to missing SVR12 data. Conclusions: While recruitment and follow-up are challenging in SSPs, preliminary data suggests adherence, treatment completion, and SVR12 are high in PWID treated with E/G engaging in SSP or MOUD. All metrics are comparable to community standards for non-PWID for treatment of HCV with direct-antiviral drugs.

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“…2,8,9 There is a need to strengthen approaches to encouraging DAA uptake for PWID, particularly in community settings such as general practice. 4,[10][11][12] In Australia, the ability of experienced general practitioners (GPs) to prescribe DAAs and unrestricted, universal access to DAAs via the PBS creates an opportunity to significantly increase HCV treatment among PWID. 2,13,14 Research indicates general practice is a common and accessible setting for PWID to access HCV care and calls for GPs to promote HCV diagnosis, treatment and follow-up with PWID.…”

Section: Discussionmentioning

confidence: 99%

How can general practitioners support people who inject drugs to engage with direct-acting antiviral treatment for hepatitis C? A qualitative study

Heard¹,

Smirnov²,

Massi³

et al. 2021

Aust J Gen Pract

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Hepatitis C cascade of care at an integrated community facility for people who inject drugs

Cited by 14 publications

References 25 publications

A multi‐site, nurse‐coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia

A multi‐site, nurse‐coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia

Hepatitis C Treatment Among People Who Use Drugs in an Office-Based Opioid Treatment Program Versus a Syringe Exchange Program: A Real-World Prospective Clinical Trial

How can general practitioners support people who inject drugs to engage with direct-acting antiviral treatment for hepatitis C? A qualitative study

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