The cascade of care for an Australian community-based hepatitis C treatment service

Amanda Jane Wade, Diana M Macdonald, Joseph Samuel Doyle, Adam Gordon, Stuart Keith Roberts, Alexander James V Thompson, Margaret Elena Hellard

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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.
Original languageEnglish
Pages (from-to)1 - 12
Number of pages12
JournalPLoS ONE
Issue number11 (Art. No: e0142770)
Publication statusPublished - 2015

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