Hospital vs Primary Care Comparison of Treatment Outcomes in Hepatitis C

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Researchers in Australia found that treatment with direct acting antivirals for hepatitis C in the primary care setting is effective in treatment uptake in people who inject drugs, compared with referrals to hospital-based services.

Providing direct acting antivirals (DAAs) for hepatitis C virus (HCV) in primary care significantly increases treatment uptake and cure rates in people who inject drugs (PWID) compared with referral to hospital-based services, according to a randomized, controlled study published in Clinical Infectious Diseases.1

In high income countries, the HCV epidemic is driven by transmission associated with injection drug use.2,3 In the past, HCV treatment with pegylated interferon had poor efficacy, significant morbidity, and could only be accessed from specialist physicians located in hospital clinics. The introduction of DAAs has revolutionized the HCV treatment landscape,4,5 and the World Health Organization (WHO) has set HCV elimination targets for 2030 of an 80% reduction in new cases and a 65% reduction in mortality.6 To reach these goals, it is essential to increase access to DAAs, especially among PWID.1 Thus, researchers in Australia and New Zealand randomly assigned 136 PWID with HCV to receive DAAs at their primary care sites (n=70) or at a local hospital (n=66) to determine whether people treated in primary care had a noninferior sustained virologic response at week 12 (SVR12) rate compared with historical controls. They found that the SVR12 rate (100%) of people treated in primary care was noninferior when compared with historical controls (85% assumed). They also found that the proportion of patients beginning treatment in primary care (75%, 43/57) was significantly higher than in local hospitals (34%, 18/53) (P <.001), and the proportion of participants with SVR12 was significantly higher in primary care compared with local hospitals (49%, 28/57 and 30%, 16/53; P =0.043).

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The authors concluded that, “Broadening access to DAAs beyond hospital-based services must occur if their benefits are to be fully realized. Strategies that engage priority populations such as PWID are key to achieving hepatitis C elimination.”

1. Wade AJ, Doyle JS, Gane E, et al. Outcomes of treatment for hepatitis C in primary care compared to hospital-based care: a randomized controlled trial in people who inject drugs [published online June 22, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz546

2. Lanini S, Easterbrook PJ, Zumla A, Ippolito G. Hepatitis C: global epidemiology and strategies for control. Clin Microbiol Infect. 2016;22(10):833-838.

3. Nelson PK, Mathers BM, Cowie B, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet. 2011;378(9791):571-583.

4. Feld JJ, Kowdley KV, Coakley E, et al. Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med. 2014;370(17):1594-1603.

5. Kowdley KV, Gordon SC, Reddy KR, et al. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med. 2014;370(20):1879-1888.

6. Global Hepatitis Report, 2017. World Health Organization website. Updated April 2017. Accessed July 29, 2019.