A decentralised, multidisciplinary model of care facilitates treatment of hepatitis C in regional Australia
| Autor: | Greg Spice, Penny Fox, Peter Boyd, Andy H. Lee, Josh Hanson, Darren Russell |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Ledipasvir
medicine.medical_specialty Daclatasvir Sofosbuvir Epidemiology hepatitis C direct-acting antiviral therapy regional Australia model of care service delivery Immunology Population Microbiology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Virology Internal medicine Medicine 030212 general & internal medicine Prospective cohort study Adverse effect education Original Research education.field_of_study Shared care business.industry Public Health Environmental and Occupational Health Hepatitis C medicine.disease QR1-502 Infectious Diseases chemistry 030211 gastroenterology & hepatology Public aspects of medicine RA1-1270 business medicine.drug |
| Zdroj: | Journal of Virus Eradication, Vol 4, Iss 3, Pp 160-164 (2018) Journal of Virus Eradication |
| ISSN: | 2055-6640 |
| DOI: | 10.1016/s2055-6640(20)30270-3 |
| Popis: | Objectives Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) has excellent cure rates and minimal side effects. Despite the high burden of disease, strategies to ultimately eradicate HCV are being developed. However, the delivery of care in regional settings is challenging and the efficacy of decentralised models of care is incompletely defined. Methods A prospective cohort study of patients whose treatment was initiated or supervised by Cairns Hospital, a tertiary hospital which provides services to a culturally diverse population across a 380,748 km2 area in regional Australia. Patients' demographics, clinical features, DAA regimens and outcomes were recorded and correlated with their ensuing clinical course. Results Over 22 months, 734 patients were prescribed DAA therapy for HCV. No patients were prescribed interferon. Sofosbuvir/ledipasvir (n=371, 50.5%) and sofosbuvir/daclatasvir (n=287, 39.1%) were the most commonly prescribed regimens. No patients ceased treatment due to adverse effects. There were 612/734 (83.4%) patients with complete results, with 575 (94%) cured. At the end of the study period, there were 50 (6.8%) patients lost to follow-up and 72 (9.8%) awaiting SVR12 testing. The presence of cirrhosis (n=147/612, 24.1%) did not impact significantly on SVR12 rates, this being achieved in 136/147 (92.5%) cirrhotic patients versus 440/465 (94.6%) in non-cirrhotic patients (p=0.34). Treatment-experienced patients (95/612, 18.3%) were more likely to be non-responders than treatment-naïve patients (10/95 (10.5%) versus 26/517 (5%), p=0.04). Strategies to facilitate treatment included a dedicated clinical nurse consultant, education to primary health care providers, specialist outreach clinics to regional communities and shared care with general practitioners. SVR12 rates were similar amongst gastroenterologists (283/306, 92.5%), general practitioners (152/161, 94.4%), sexual health physicians (104/106, 98.1%) and other prescribers (37/39, 94.9%). Conclusions This study confirms that decentralised, multidisciplinary models of care can provide HCV treatment in regional and remote settings with excellent outcomes. |
| Databáze: | OpenAIRE |
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