PMO-144 Experience of managing patients with hepatitis C in outreach

IntroductionSubjects who acquire Hepatitis C (HCV) from injecting drug use (IDU) and attend drug rehabilitation programs are a “hard to reach” group and often don't access treatment for HCV. In our experience, their non-attendance at secondary care clinics is ∼60%. In order to improve access to treatment for this group we established three outreach clinics at drug treatment centres in North of Tyne Region. Our aim was to review the outcomes for patients attending these outreach clinics.MethodsRetrospective review of patients referred to three outreach clinics: 1. Plummer Court (PC), an addiction psychiatry led drug and alcohol centre in Newcastle 2. Bridge View (BV), a GP led drug treatment centre in Newcastle 3. A GP surgery in Blyth, Northumberland associated with the Harm Reduction service. Data were collected on demographics, attendance rates and treatment outcomes.ResultsA total of 133 patients were referred to the three clinics and 96 (72%) attended ≥1 appointment. Their demographic and clinical data are shown in Abstract PMO-144 table 1. Of the 96 seen, 75 (78%) had treatment workup, but 21 (22%) were deemed “not ready” for treatment due to on-going IDU, alcohol excess, psychiatric disease or unfavourable social circumstances. Of the 75 subjects who had treatment workup, 25 (33%) have since either failed to attend appointments, elected to delay treatment or had contraindications (including two decompensated cirrhotics and two with hepatocellular carcinoma). 30 (40%) commenced treatment and 20 (27%) patients are waiting to start treatment. Of the 30 who started treatment, 11 (37%) completed treatment (five had sustained virological response, one relapsed and five awaiting post-treatment results), 13 (43%) are currently in treatment and 6 (20%) did not complete therapy (poor compliance or side effects).Abstract PMO-144 Table 1PCBVGPClinic establishedJanuary 2008October 2010January 2011Patients referred (n)654127Patients attend ≥1 clinic443121Non-attendance (%)32%24%22%Age (median + range)36 (19–62)36 (27–64)37 (27–48)HCV G1/457%29%45%Methadone/subutex use84%100%62%Cirrhotics n (%)7 (16%)4 (11%)1 (5%)“Not ready” for treatment (%)34%10%14%ConclusionOutreach clinics in drug treatment centres substantially improved attendance rates of for patients with HCV and a history of substance misuse. More than 50% of subjects seen in outreach clinics commenced or are waiting to start HCV treatment. If adopted nationwide, this model of care may improve access to HCV