The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service
Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatme...
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| Veröffentlicht in: | PloS one 2015-11, Vol.10 (11), p.e0142770 |
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| creator | Wade, Amanda J Macdonald, Diana M Doyle, Joseph S Gordon, Adam Roberts, Stuart K Thompson, Alexander J Hellard, Margaret E |
| description | Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community.
A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.
Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124 (48%) injected in the last month. Of 201 (72%) patients who had their fibrosis staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis. Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30-5.00, p = 0.006).
Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia-benefits that should be realised as direct-acting antiviral agents become available. |
| doi_str_mv | 10.1371/journal.pone.0142770 |
| format | Article |
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A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.
Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124 (48%) injected in the last month. Of 201 (72%) patients who had their fibrosis staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis. Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30-5.00, p = 0.006).
Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia-benefits that should be realised as direct-acting antiviral agents become available.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0142770</identifier><identifier>PMID: 26562516</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Addictions ; Adult ; Antiviral agents ; Antiviral Agents - therapeutic use ; Australia - epidemiology ; Clinics ; Communities ; Community Health Services ; Drug abuse ; Drug use ; Drugs ; Family physicians ; Female ; Fibrosis ; Gastroenterology ; Genotypes ; Health care ; Health care access ; Health services ; Hepacivirus - drug effects ; Hepacivirus - isolation & purification ; Hepatitis ; Hepatitis C ; Hepatitis C - complications ; Hepatitis C - drug therapy ; Hepatitis C - epidemiology ; Hepatitis C - pathology ; Hospitals ; Humans ; Infections ; Infectious diseases ; Inner city ; Liver Cirrhosis - complications ; Liver Cirrhosis - drug therapy ; Liver Cirrhosis - pathology ; Liver Cirrhosis - virology ; Male ; Medical referrals ; Medication Adherence ; Mortality ; Patients ; Preventive medicine ; Primary care ; Public health ; Regression analysis ; Retrospective Studies ; Substance abuse treatment ; Substance Abuse, Intravenous - complications ; Systematic review ; Telemedicine ; Viruses</subject><ispartof>PloS one, 2015-11, Vol.10 (11), p.e0142770</ispartof><rights>2015 Wade et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Wade et al 2015 Wade et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-f20862da9c9589e5204f1a15891af40c1f63e1944d4583e4a7ea7fa6c6f93f2f3</citedby><cites>FETCH-LOGICAL-c526t-f20862da9c9589e5204f1a15891af40c1f63e1944d4583e4a7ea7fa6c6f93f2f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642931/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642931/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26562516$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Shoukry, Naglaa H.</contributor><creatorcontrib>Wade, Amanda J</creatorcontrib><creatorcontrib>Macdonald, Diana M</creatorcontrib><creatorcontrib>Doyle, Joseph S</creatorcontrib><creatorcontrib>Gordon, Adam</creatorcontrib><creatorcontrib>Roberts, Stuart K</creatorcontrib><creatorcontrib>Thompson, Alexander J</creatorcontrib><creatorcontrib>Hellard, Margaret E</creatorcontrib><title>The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community.
A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.
Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124 (48%) injected in the last month. Of 201 (72%) patients who had their fibrosis staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis. Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30-5.00, p = 0.006).
Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia-benefits that should be realised as direct-acting antiviral agents become available.</description><subject>Addictions</subject><subject>Adult</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Australia - epidemiology</subject><subject>Clinics</subject><subject>Communities</subject><subject>Community Health Services</subject><subject>Drug abuse</subject><subject>Drug use</subject><subject>Drugs</subject><subject>Family physicians</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Gastroenterology</subject><subject>Genotypes</subject><subject>Health care</subject><subject>Health care access</subject><subject>Health services</subject><subject>Hepacivirus - drug effects</subject><subject>Hepacivirus - isolation & purification</subject><subject>Hepatitis</subject><subject>Hepatitis C</subject><subject>Hepatitis C - complications</subject><subject>Hepatitis C - drug therapy</subject><subject>Hepatitis C - epidemiology</subject><subject>Hepatitis C - pathology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Inner city</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - drug therapy</subject><subject>Liver Cirrhosis - pathology</subject><subject>Liver Cirrhosis - virology</subject><subject>Male</subject><subject>Medical referrals</subject><subject>Medication Adherence</subject><subject>Mortality</subject><subject>Patients</subject><subject>Preventive medicine</subject><subject>Primary care</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Substance abuse treatment</subject><subject>Substance Abuse, Intravenous - complications</subject><subject>Systematic review</subject><subject>Telemedicine</subject><subject>Viruses</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNp1UU1v1DAUtBCIloV_gCAS51387fiC1EZAK1Xi0OVsvXWe26ySeLGTSv33uGxatQdOHtnzZp5nCPnI6IYJw77u45xG6DeHOOKGMsmNoa_IKbOCrzWn4vUzfELe5bynVIla67fkhGuluWL6lFxvb7FqIHtosYqhwIRViKmCsTqb85Sg7wps4jDMYzfdr88hY1td4AGmbupy1VTbhDANOE7VNaa7zuN78iZAn_HDcq7I7x_ft83F-urXz8vm7GrtFdfTOnBaa96C9VbVFhWnMjBgBTMIknoWtEBmpWylqgVKMAgmgPY6WBF4ECvy-ah76GN2Sx7ZMSMEp4zXqjAuj4w2wt4dUjdAuncROvfvIqYbB2nqfI9OacatL6kYLqXZmVrVXBuL2grc7Yrjinxb3ObdgK0vHy7hvBB9-TJ2t-4m3jmpJbeCFYEvi0CKf2bM039WlkeWTzHnhOHJgVH3UPzjlHso3i3Fl7FPz7d7GnpsWvwFcQKqkQ</recordid><startdate>20151112</startdate><enddate>20151112</enddate><creator>Wade, Amanda J</creator><creator>Macdonald, Diana M</creator><creator>Doyle, Joseph S</creator><creator>Gordon, Adam</creator><creator>Roberts, Stuart K</creator><creator>Thompson, Alexander J</creator><creator>Hellard, Margaret E</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20151112</creationdate><title>The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service</title><author>Wade, Amanda J ; Macdonald, Diana M ; Doyle, Joseph S ; Gordon, Adam ; Roberts, Stuart K ; Thompson, Alexander J ; Hellard, Margaret E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-f20862da9c9589e5204f1a15891af40c1f63e1944d4583e4a7ea7fa6c6f93f2f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Addictions</topic><topic>Adult</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - 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To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community.
A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.
Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124 (48%) injected in the last month. Of 201 (72%) patients who had their fibrosis staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis. Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30-5.00, p = 0.006).
Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia-benefits that should be realised as direct-acting antiviral agents become available.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26562516</pmid><doi>10.1371/journal.pone.0142770</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Public Library of Science（OA）; EZB-FREE-00999 freely available EZB journals; PubMed Central; Directory of Open Access Journals; Free Full-Text Journals in Chemistry |
| subjects | Addictions Adult Antiviral agents Antiviral Agents - therapeutic use Australia - epidemiology Clinics Communities Community Health Services Drug abuse Drug use Drugs Family physicians Female Fibrosis Gastroenterology Genotypes Health care Health care access Health services Hepacivirus - drug effects Hepacivirus - isolation & purification Hepatitis Hepatitis C Hepatitis C - complications Hepatitis C - drug therapy Hepatitis C - epidemiology Hepatitis C - pathology Hospitals Humans Infections Infectious diseases Inner city Liver Cirrhosis - complications Liver Cirrhosis - drug therapy Liver Cirrhosis - pathology Liver Cirrhosis - virology Male Medical referrals Medication Adherence Mortality Patients Preventive medicine Primary care Public health Regression analysis Retrospective Studies Substance abuse treatment Substance Abuse, Intravenous - complications Systematic review Telemedicine Viruses |
| title | The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service |
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