The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service
AuthorWade, AJ; Macdonald, DM; Doyle, JS; Gordon, A; Roberts, SK; Thompson, AJ; Hellard, ME
Source TitlePLoS One
PublisherPUBLIC LIBRARY SCIENCE
Medicine (St Vincent's)
Document TypeJournal Article
CitationsWade, A. J., Macdonald, D. M., Doyle, J. S., Gordon, A., Roberts, S. K., Thompson, A. J. & Hellard, M. E. (2015). The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service. PLOS ONE, 10 (11), https://doi.org/10.1371/journal.pone.0142770.
Access StatusOpen Access
BACKGROUND: Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community. METHODS: A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake. RESULTS: Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124 (48%) injected in the last month. Of 201 (72%) patients who had their fibrosis staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis. Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30-5.00, p = 0.006). CONCLUSIONS: Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia-benefits that should be realised as direct-acting antiviral agents become available.
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