title: The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service.
abstract: 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.
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Wade
authors.affiliation: Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Macdonald
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.affiliation: Department of Gastroenterology, The Alfred, Melbourne, Victoria, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Department of Gastroenterology, The Alfred, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Roberts
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Thompson
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.|Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Hellard
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D003153:Community Health Services; D005260:Female; D016174:Hepacivirus / Q000187:drug effects / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D008297:Male; D055118:Medication Adherence; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D000998:Antiviral Agents