Theme: Clinical Research Year: 2015
Introduction:
The majority of cases of existing and newly acquired hepatitis C virus (HCV) infection are found in people who inject drugs (PWID). Unfortunately a number of barriers limit treatment uptake by this population group in traditional hospital-based hepatology clinics. Enabling access to HCV treatment within drug & alcohol treatment services has been identified as one method of improving treatment uptake amongst PWID. This report details the establishment of such a service and its’ results.
Methods:
In 2009 a funding arrangement between Next Step Drug & Alcohol Services and WA Department of Health’s Communicable Disease Control Directorate enabled the creation of a Blood Borne Virus (BBV) Nurse position within our community-based treatment service. Relationships were also developed between the service and the hepatology department in a local tertiary hospital. A hepatologist was able to provide Clinical Research time on a fortnightly to monthly basis, visiting the service and reviewing potential HCV treatment candidates. Once seen the remainder of treatment is carried out at the service by the BBV nurse and a clinic doctor.
Results:
To date treatment has been commenced in fifty patients. Eight have yet to complete treatment and follow-up testing. Of the remaining forty-two, twenty-five (59.5%) have achieved a sustained virological response (SVR). SVR rates of 69.0% (20/29) in genotypes 2 & 3 and 38.5% (5/13) in genotype 1 have been achieved. Disengaging from treatment remains a significant barrier to successful treatment, with nine patients (21.4%) so far lost to follow-up.
Conclusion:
Treatment for hepatitis C can be successfully provided through a community drug & alcohol treatment service. This can not only improve access to treatment for PWID, but also improve the knowledge and awareness of staff working in the service. Treatment length and side effects appear to inhibit treatment completion in a significant number of patients.