title: Task-Shifting: An Approach to Decentralized Hepatitis C Treatment in Medically Underserved Areas.
abstract: BACKGROUND
  Despite the availability of safe and effective direct-acting antiviral drugs (DAAs), the vast majority of patients with chronic hepatitis C (HCV) in the USA remain untreated, in part due to lack of access to specialist providers.
  
  
  OBJECTIVE
  To determine the effectiveness of DAA-based treatment in medically underserved areas in California, in a healthcare model dependent on task-shifting--wherein a visiting hepatologist assesses patients for treatment eligibility, but subsequent routine follow-up evaluation of patients prescribed treatment is devolved to a part-time licensed vocational nurse under remote supervision of the hepatologist.
  
  
  METHODS
  We retrospectively determined rates of sustained virologic response 12 weeks after treatment completion (SVR-12), adverse events, and treatment discontinuations in patients who received sofosbuvir-based DAA regimens between December 2013 and November 2014.
  
  
  RESULTS
  Despite limited specialist provider involvement in medically underserved areas, all but two of 58 patients completed treatment, and 88 % of patients achieved the curative endpoint of undetectable HCV RNA 12 weeks after completing treatment (sustained virologic response, SVR-12). Almost 80 % of patients with cirrhosis and 85 % of patients with prior treatment experience achieved SVR-12.
  
  
  CONCLUSIONS
  Treatment effectiveness with sofosbuvir-based regimens in medically underserved areas utilizing task-shifting from a specialist to a mid-level provider is comparable to those achieved in pivotal clinical trials for these regimens, and to “real-world” experiences of tertiary care centers in the USA.
authors.forename: Channa R
authors.initials: CR
authors.lastname: Jayasekera
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Perumpail
authors.forename: David T
authors.initials: DT
authors.lastname: Chao
authors.forename: Edward A
authors.initials: EA
authors.lastname: Pham
authors.forename: Avin
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002140:California; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use; D000069616:Simeprevir / Q000008:administration & dosage / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D000069616:Simeprevir; D000069474:Sofosbuvir