title: Delivery of treatment for hepatitis C virus infection in the primary care setting.
abstract: OBJECTIVE
  The aim of this study was to evaluate the feasibility, safety and efficacy of treatment for chronic hepatitis C virus (HCV) infection through a primary care-based model for the delivery of HCV services in New South Wales (NSW), Australia.
  
  
  METHODS
  This observational cohort study recruited participants through seven primary care clinics in NSW, Australia, between November 2010 and June 2013. Patients with HCV genotype 2/3 were treated without specialist review, whereas those with genotype 1 required an initial specialist review. Treatment consisted of pegylated interferon-α-2a/2b and ribavirin. Sustained virological response and adverse events were evaluated.
  
  
  RESULTS
  Among 41 participants (mean age 44 years, 73% men) initiating treatment with pegylated interferon-α-2a/2b and ribavirin, 90% had injected drugs ever, 16% had injected drugs in the past 30 days and 56% had ever received opioid substitution treatment. HCV genotype 1 and genotype 2/3 occurred in 17% (n=7) and 83% (n=34). Treatment was completed in 83% (34 of 41), with seven discontinuations [adverse event (depression), n=1; patient decision, n=1; lost to follow-up, n=3; virological nonresponse, n=2]. In an intent-to-treat analysis, sustained virological response was 71% overall (29 of 41), 43% in genotype 1 (three of seven) and 76% in genotype 2/3 (26 of 34).
  
  
  CONCLUSIONS
  Initiation of HCV treatment in the primary care setting is an effective alternative for selected patients and may contribute towards increasing access to HCV care.
authors: aThe Australasian Society for HIV Medicine (ASHM) bEast Sydney Doctors cThe Kirby Institute, UNSW Australia dThe Byrne Surgery, Sydney eClinic 96, Orange fCowra Medical Associates, Cowra gAsquith Medical Centre, Asquith hHunter Pharmacotherapy, Newcastle iDr Doong's Clinic, Burwood, New South Wales, Australia.
authors: David
authors: D
authors: Baker
authors: Maryam
authors: M
authors: Alavi
authors: Amanda
authors: A
authors: Erratt
authors: Sonja
authors: S
authors: Hill
authors: Annie
authors: A
authors: Balcomb
authors: Richard
authors: R
authors: Hallinan
authors: Sharmila
authors: S
authors: Siriragavan
authors: David
authors: D
authors: Richmond
authors: John
authors: J
authors: Smart
authors: Julian
authors: J
authors: Keats
authors: Nicholas
authors: N
authors: Doong
authors: Pip
authors: P
authors: Marks
authors: Jason
authors: J
authors: Grebely
authors: Gregory J
authors: GJ
authors: Dore
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010865:Pilot Projects; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D011320:Primary Health Care / Q000458:organization & administration*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a