Theme: Models of Care Year: 2018
Background:
Chronic hepatitis C virus (HCV) infection treatment is mainly delivered by specialty services
in Canada. As recent paradigm changes in HCV treatment give an opportunity to treat HCV
with Direct Acting Antivirals (DAAs), which are more effective and simple to administer, they
can be readily administered at a primary care level. The objective of this study was to describe
a successful HCV treatment multicenter model used in prisons and community-based clinics
and proposes the feasibility of this model in other primary care settings.
Description of model of care:
Eight Federal Canadian prisons and two community-based clinics in Vancouver were
included. 439 HCV-infected patients were treated in 10 centers by a healthcare team under
the supervision of one infectious diseases specialist from March 2015 to December 2017.
Cases were screened by trained nurses; liver fibrosis was determined via elastography.
Treatment was initiated by an infectious diseases specialist. Cases were followed-up by HCVTreatment-protocol-trained nurses; seen throughout treatment by a specialist.
Effectiveness:
Of 439 cases treated, 322 (73%) were male, 13 (3%) were co-infected with HIV, and mean
age was 56.7 years. Most were treated for 12 weeks; seen by the nurses on average 4-5 times
and by the specialist 2-3 times during treatment. There were 56 (13%) cases of reported
adverse effects. Post-treatment HCV RNA determination was available for 389 cases; 381
(98 %) achieved Sustained Virologic Response (cure).
Conclusion and next steps:
Our HCV care model demonstrated that treatment in multiple centers can be successfully
achieved by trained primary healthcare professionals with input from specialists. This model
of HCV treatment can be adopted in diverse settings and can address most cases (~90%).
This will reduce wait times for HCV treatment and reduce specialist service strain. It will
contribute to the goal of elimination of HCV while helping address the epidemic.