Susan Nouch1, Lesley Gallagher2, Margaret Erickson3, Rabab Elbaharia4, Wendy Zhang5, Lu Wang6, Nic Bacani7, Deborah Kason8, Holly Kleban9, Laura Knebel10, David Hall11, Rolando Barrios12, Mark Hull13. 1. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada; University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada. Electronic address: susan.nouch@vch.ca. 2. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada. Electronic address: Lesley.Gallagher@vch.ca. 3. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada; BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Electronic address: merickson@cfenet.ubc.ca. 4. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada. 5. BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Electronic address: wzhang@cfenet.ubc.ca. 6. BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Electronic address: cwang@cfenet.ubc.ca. 7. BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Electronic address: nbacani@cfenet.ubc.ca. 8. University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; Vancouver Coastal Health Authority, Downtown Community Health Centre, 569 Powell St, Vancouver, BC V6A 1G9, Canada. Electronic address: Deborah.Kason@vch.ca. 9. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada. Electronic address: Holly.Kleban@vch.ca. 10. University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; Vancouver Coastal Health Authority, Downtown Community Health Centre, 569 Powell St, Vancouver, BC V6A 1G9, Canada. Electronic address: Laura.Knebel@vch.ca. 11. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada; University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada. Electronic address: David.Hall4@vch.ca. 12. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada; University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Electronic address: rbarrios@cfenet.ubc.ca. 13. Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada; University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. Electronic address: mhull@cfenet.ubc.ca.
Abstract
BACKGROUND: Treatment of hepatitis c virus (HCV) with direct-acting-antivirals (DAAs) by family physicians in primary care and addiction settings may allow treatment expansion to inner-city populations, including people who inject drugs (PWID). Real-world data however, suggests high rates of non-attendance to SVR 12 testing. This study examines outcomes of HCV treatment delivered by family physicians working in interdisciplinary treatment programs, integrated into inner-city primary care clinics. METHODS: In this prospective cohort, participants completed baseline questionnaires, including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR 12) if HCV RNA was undetectable 12 weeks following end of therapy, and were recorded as lost to follow-up (LTFU) if they did not present for an HCV follow-up visit. SVR was calculated in intention to treat (ITT) as well as modified intention to treat (mITT) analysis, which excluded those who completed treatment but had no SVR 12 result. A logistic regression model assessed factors associated with LTFU. RESULTS: Of 138 individuals included in the analysis, 52% were on opioid agonist therapy (OAT), 75% reported a history of injection drug use (IDU), with 25% reporting IDU in the month prior to treatment initiation. ITT SVR across all sites and genotypes was 86% and mITT was 95%. There was a significant difference in mITT for those reporting recent IDU compared to those who did not (87% vs 99% p = 0.03). While 13% were LTFU at SVR 12, participants receiving OAT in the same clinic as HCV treatment were less likely to be LTFU (aOR 0.09(0.02-0.46)). CONCLUSION: HCV treatment by family physicians, along with interdisciplinary teams, can be successful in inner-city populations in the era of DAAs; however, follow-up after treatment is a challenge. Integrating OAT in the same location as HCV treatment may help to improve follow-up.
BACKGROUND: Treatment of hepatitis c virus (HCV) with direct-acting-antivirals (DAAs) by family physicians in primary care and addiction settings may allow treatment expansion to inner-city populations, including people who inject drugs (PWID). Real-world data however, suggests high rates of non-attendance to SVR 12 testing. This study examines outcomes of HCV treatment delivered by family physicians working in interdisciplinary treatment programs, integrated into inner-city primary care clinics. METHODS: In this prospective cohort, participants completed baseline questionnaires, including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR 12) if HCV RNA was undetectable 12 weeks following end of therapy, and were recorded as lost to follow-up (LTFU) if they did not present for an HCV follow-up visit. SVR was calculated in intention to treat (ITT) as well as modified intention to treat (mITT) analysis, which excluded those who completed treatment but had no SVR 12 result. A logistic regression model assessed factors associated with LTFU. RESULTS: Of 138 individuals included in the analysis, 52% were on opioid agonist therapy (OAT), 75% reported a history of injection drug use (IDU), with 25% reporting IDU in the month prior to treatment initiation. ITT SVR across all sites and genotypes was 86% and mITT was 95%. There was a significant difference in mITT for those reporting recent IDU compared to those who did not (87% vs 99% p = 0.03). While 13% were LTFU at SVR 12, participants receiving OAT in the same clinic as HCV treatment were less likely to be LTFU (aOR 0.09(0.02-0.46)). CONCLUSION:HCV treatment by family physicians, along with interdisciplinary teams, can be successful in inner-city populations in the era of DAAs; however, follow-up after treatment is a challenge. Integrating OAT in the same location as HCV treatment may help to improve follow-up.
Authors: Claire E Kendall; Michael Fitzgerald; Jessy Donelle; Jeffrey C Kwong; Chrissi Galanakis; Rob Boyd; Curtis L Cooper Journal: Can Liver J Date: 2020-06-04
Authors: Jackie Habchi; Aurielle M Thomas; Sophie Sprecht-Walsh; Elenita Arias; Jeffrey Bratberg; Linda Hurley; Susan Hart; Lynn E Taylor Journal: Open Forum Infect Dis Date: 2020-10-13 Impact factor: 3.835