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Facilitating treatment of HCV in primary care in regional Australia: closing the access gap
  1. Lauren White1,
  2. Ali Azzam1,
  3. Lauren Burrage1,
  4. Clare Orme1,
  5. Barbara Kay1,
  6. Sarah Higgins1,
  7. Simone Kaye1,
  8. Andrew Sloss1,
  9. Jennifer Broom1,2,
  10. Nicola Weston1,
  11. Jonathan Mitchell1,
  12. James O’Beirne1,3
  1. 1Sunshine Coast University Hospital, Birtinya, Queensland, Australia
  2. 2University of Queensland, Brisbane, Queensland, Australia
  3. 3University of the Sunshine Coast, Sippy Downs, Queensland, Australia
  1. Correspondence to Professor James O’Beirne, Department of Hepatology, Sunshine Coast University Hospital, Birtinya, QLD 4575, Australia; james.obeirne{at}health.qld.gov.au

Abstract

Background Australia 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.

Objectives In order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland.

Design Retrospective analysis of a prospectively recorded HCV treatment database.

Interventions A 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.

Results 327 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%.

Conclusion Community-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

  • hepatitis c
  • primary care
  • antiviral therapy

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Footnotes

  • Contributors JM and JO’B conceived and planned the study. CO, BK, SH, SK, AS, JB and NW performed the study and collected data. LW, AA, LB and JO’B drafted the manuscript. JB provided important intellectual content. JO’B and JM are guarantors of the article.

  • Funding Australian Centre for Health Service Innovation (AusHSI)—Integrated care innovation fund.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Prince Charles Hospital, Brisbane, Human Research Ethics Committee (HREC/17/QPCH/365).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Further data including all biochemistry and clinical data are available. We are happy to share the de-identified data after appropriate ethics submission.

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