Hepatitis C Treatment by Primary Care Teams in Inner-City Community Health Clinics: A Prospective Cohort Study

Author: Nouch S, Gallagher L, Erickson M, Grewal A, Kleban H, Quesnelle J, Persaud S, Kason D, Pare D, Knebel L, Viljoen M, Zhang W, Bacani N, Sereda P, Shoveller J, Hall D, Norbury M, Barrios R, Hull M

Theme: Clinical Research Year: 2017

Background: Efforts to scale-up treatment of Hepatitis C (HCV) in vulnerable populations including those who inject drugs (PWID) necessitates novel and integrated models of care. HCV treatment by family physicians in primary care settings may allow large-scale uptake, however little data exists to demonstrate efficacy of primary care programs providing direct acting antivirals (DAAs).

Methods: This prospective cohort evaluated outcomes of HCV treatment delivered by family physicians with HCV and addiction expertise working in multidisciplinary HCV treatment programs located within three Vancouver inner-city primary care clinics between September 2015 and February 2017. Participants completed baseline questionnaires including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR12) if HCV RNA was undetectable 12 weeks following the end of therapy, or recorded as lost-to follow-up (LTFU) if no results were obtained. A univariate model assessed factors associated with LTFU.

Results: 104 individuals (79% male, median age at baseline was 53 years [q1-q3 47-60 years]) were included in the analysis. Overall 31% had evidence of cirrhosis, 17% were treatment experienced, and 74% of participants reported history of injection drug use, with 25% reporting injection drug use in the month prior to treatment initiation. 52% of participants were on opiate replacement therapy. 89% of participants had not directly seen a specialist physician for HCV management in the year prior to treatment. Of those with documented lab work, SVR 12 was 97.5%, however 16 were LTFU (15%). Those LTFU were more likely to be younger than those with documented SVR(p=0.044).

Conclusion: HCV treatment in the primary care setting by multidisciplinary teams including family physicians can be successful in inner-city populations in the era of DAAs, however efforts are needed to ensure ongoing engagement in care.

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