James Haridy1,2,3, Guru Iyngkaran1,2,4, Amanda Nicoll1,3,5, Kate Muller6, Mark Wilson7, Alan Wigg6, Jeyamani Ramachandran6, Renjy Nelson8,9, Stephen Bloom3,5, Joseph Sasadeusz10, Sally Watkinson10, Anton Colman11, Rosalie Altus6, Emma Tilley6, Jeffrey Stewart6,9, Geoff Hebbard2, Danny Liew12, Edmund Tse8,11. 1. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia. 2. Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 3. Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia. 4. Department of Gastroenterology, Royal Darwin Hospital, Darwin, Northern Territory, Australia. 5. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia. 6. Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, South Australia, Australia. 7. Department of Gastroenterology, Royal Hobart Hospital, Hobart, Tasmania, Australia. 8. School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia. 9. Department of Infectious Diseases, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia. 10. Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 11. Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia. 12. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: A unique model of care was adopted in Australia following introduction of universal subsidised direct-acting antiviral (DAA) access in 2016 in order to encourage rapid scale-up of treatment. Community-based medical practitioners and integrated hepatitis nurses initiated DAA treatment with remote hepatitis specialist approval of the planned treatment without physical review. AIMS: To evaluate outcomes of community-based treatment of hepatitis C virus (HCV) through this remote consultation process in the first 12 months of this model of care. METHODS: A retrospective chart review of patients undergoing community-based HCV treatment from general practitioners and integrated hepatitis nurse consultants through the remote consultation model in three state jurisdictions in Australia from 1 March 2016 to 28 February 2017. RESULTS: Sustained virological response at 12 weeks (SVR12) was confirmed in 383 (65.1%) of 588 subjects intended for treatment with a median follow-up time of 12 months (interquartile range 9-14 months). The SVR12 test was not performed in 159 (27.0%) of 588 and 307 (52.2%) of 588 did not have liver biochemistry rechecked following treatment. Subjects who completed follow up exhibited high SVR12 rates (383/392; 97.7%). Nurse-led treatment was associated with higher confirmation of SVR12 (73.7% vs 62.4%; P = 0.01) and liver biochemistry testing post treatment (57.5% vs 45.0%; P = 0.01). CONCLUSIONS: Community-based management of HCV through remote specialist consultation may be an effective model of care. Failure to check SVR12, recheck liver biochemistry and appropriate surveillance in patients with cirrhosis may emerge as significant issues requiring further support, education and refinement of the model to maximise effectiveness of future elimination efforts.
BACKGROUND: A unique model of care was adopted in Australia following introduction of universal subsidised direct-acting antiviral (DAA) access in 2016 in order to encourage rapid scale-up of treatment. Community-based medical practitioners and integrated hepatitis nurses initiated DAA treatment with remote hepatitis specialist approval of the planned treatment without physical review. AIMS: To evaluate outcomes of community-based treatment of hepatitis C virus (HCV) through this remote consultation process in the first 12 months of this model of care. METHODS: A retrospective chart review of patients undergoing community-based HCV treatment from general practitioners and integrated hepatitis nurse consultants through the remote consultation model in three state jurisdictions in Australia from 1 March 2016 to 28 February 2017. RESULTS: Sustained virological response at 12 weeks (SVR12) was confirmed in 383 (65.1%) of 588 subjects intended for treatment with a median follow-up time of 12 months (interquartile range 9-14 months). The SVR12 test was not performed in 159 (27.0%) of 588 and 307 (52.2%) of 588 did not have liver biochemistry rechecked following treatment. Subjects who completed follow up exhibited high SVR12 rates (383/392; 97.7%). Nurse-led treatment was associated with higher confirmation of SVR12 (73.7% vs 62.4%; P = 0.01) and liver biochemistry testing post treatment (57.5% vs 45.0%; P = 0.01). CONCLUSIONS: Community-based management of HCV through remote specialist consultation may be an effective model of care. Failure to check SVR12, recheck liver biochemistry and appropriate surveillance in patients with cirrhosis may emerge as significant issues requiring further support, education and refinement of the model to maximise effectiveness of future elimination efforts.
Authors: Jasmine Yee; Joanne M Carson; Behzad Hajarizadeh; Joshua Hanson; James O'Beirne; David Iser; Phillip Read; Anne Balcomb; Joseph S Doyle; Jane Davies; Marianne Martinello; Philiipa Marks; Gregory J Dore; Gail V Matthews Journal: Hepatol Commun Date: 2021-11-02