Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada
| Autor: | Margaret Erickson, Rabab Elbaharia, Deborah Kason, Holly Kleban, Rolando Barrios, Lu Wang, Nic Bacani, Laura Knebel, Lesley Gallagher, Wendy Zhang, Susan Nouch, David Hall, Mark Hull |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Canada medicine.medical_specialty Hepatitis C virus media_common.quotation_subject Medicine (miscellaneous) Primary care medicine.disease_cause Logistic regression Antiviral Agents Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Prospective Studies 030212 general & internal medicine Cities Lost to follow-up Substance Abuse Intravenous Prospective cohort study media_common Intention-to-treat analysis Primary Health Care business.industry Health Policy Addiction virus diseases Hepatitis C Middle Aged medicine.disease digestive system diseases Female Lost to Follow-Up 030211 gastroenterology & hepatology business |
| Zdroj: | International Journal of Drug Policy. 59:76-84 |
| ISSN: | 0955-3959 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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