title: District general hospital networks can provide safe and effective hepatitis C treatment: results of a 5-year audit.
abstract: BACKGROUND
  Chronic hepatitis C treatment is well described in randomized-controlled trials (RCTs). We aimed to determine whether these findings can be extrapolated to treatment programmes delivered by nurse specialists in district general hospitals (DGHs).
  
  
  METHODS
  Within the Dorset viral hepatitis network, chronic hepatitis C patients were treated in three DGHs by nurse specialists working under the supervision of four lead clinicians. Between January 2007 and January 2012, standard of care was ribavirin and pegylated interferon-α2a administered for 24 weeks (G2/3) and 48 weeks (G1/4). Retrospective analysis of the network's database was carried out and comparisons were made with a multicentre RCT.
  
  
  RESULTS
  In total, 242 completed patient episodes were available for analysis. Ninety per cent (219) were treatment naive. G1 patients represented 49% (107) of this cohort; 2% (six) were hepatitis B/HIV coinfected and 97% (212) were Whites. Overall, 11% (23) were lost to follow-up within 24 weeks of completing treatment. On the basis of the intention to treat, the sustained virological response rates were 45 (48/107), 60 (63/105) and 57% (4/7) for patients infected with hepatitis C virus G1, G2/3 and G4, respectively. These results are comparable with RCT data (P=0.4973, 0.1359 and 0.9552). Treatment was discontinued in 3.7% (eight) of patients because of a laboratory abnormality and 9.6% (21) because of other medical complications or side-effect intolerance. These proportions are similar to those observed in the RCT (P=0.0873 and 0.5613).
  
  
  CONCLUSIONS
  Specialist nurses supported by a network of DGHs can deliver a high-quality hepatitis C service across a broad geographical area.
authors.affiliation: Department of Hepatology, University Hospital Southampton, Southampton, UK.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hydes
authors.forename: Hazel
authors.initials: H
authors.lastname: Allen
authors.forename: Safa
authors.initials: S
authors.lastname: Al-Shamma
authors.forename: Christopher
authors.initials: C
authors.lastname: Hovell
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Sharer
authors.forename: Earl J
authors.initials: EJ
authors.lastname: Williams
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003695:Delivery of Health Care / Q000592:standards; D004359:Drug Therapy, Combination; D004739:England; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy*; D006767:Hospitals, District / Q000592:standards; D006769:Hospitals, General / Q000592:standards; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008485:Medical Audit; D009720:Nurse Clinicians; D010348:Patient Care Team; D061214:Patient Safety; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D059039:Standard of Care; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a