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Providing DAAs to PWID in primary care increases uptake, cure rates
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Providing direct acting antivirals, or DAAs, for hepatitis C virus infection in primary care settings significantly increases treatment uptake and cure rates in people who inject drugs, or PWID, suggesting HCV treatment should be available in primary care, researchers found.
“In 2016, WHO set hepatitis C elimination targets for 2030: 80% reduction in new cases and 65% reduction in mortality. For this to be achieved, it is essential that there is increased access and uptake of DAAs,” Amanda J. Wade, MBBS, PhD, an infectious disease physician at the Burnet Institute in Melbourne, Australia, and colleagues wrote.
“Worldwide the availability of DAAs is variable due to their cost, patient and provider-based restrictions. The availability of DAAs in primary care is poor, limiting access to treatment. Moreover, people with hepatitis C commonly report experiencing stigma and discrimination in health care settings, which creates an additional barrier to treatment.”
To determine the effectiveness of providing DAAs in primary care compared with hospital-based specialist care, Wade and colleagues randomly assigned 136 PWID with HCV attending primary care sites in Australia or New Zealand to receive DAAs at their primary care site (n = 70) or a local hospital (n = 66).
According to the study, 70 study participants were randomly assigned to primary care and 66 to the local hospital. The SVR at week 12 of people treated in primary care was significantly higher than that among those treated in hospitals, 49% vs. 30% respectively (P = .043; RR = 1.63; 95% CI, 1-2.65), Wade and colleagues reported. Additionally, they reported that the intention-to-treat analysis showed that the proportion of participants who started treatment in primary care (75%) was significantly higher than that in local hospitals (34%) (P < .001; RR = 2.48; 95% CI, 1.54-3.95).
“Providing DAAs in primary care increases treatment uptake and cure in PWID, compared to hospital-based specialist care,” the authors concluded. “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.” – by Caitlyn Stulpin
Disclosures: Wade reports receiving funding for investigator-initiated research from AbbVie. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Michael S. Saag, MD
I am not surprised at the findings in this study. They mirror what we have observed in Alabama over the last 4 years in a project where we set up primary care clinics, including public health and Federally Qualified Heath Clinics to test and treat their patients for HCV locally. Their outcomes are at least as good as what we observe at our referral hospital, where cure rates (SVR 12) are over 95% among those who initiate and complete the full course of therapy. The primary clinics do better overall, owing to the high “no show” rate for an initial visit at our referral center.
In my opinion, the treatment of HCV is a task best done in the primary care setting, provided the primary care clinician is trained in the nuances of HCV management, screens each patient for the presence of advanced liver disease (cirrhosis) and refers those with cirrhosis to a hepatologist for care. Because the majority of patients with HCV do not have advanced liver disease, this means that most HCV patients can and should be treated in their primary care offices and clinics.
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