title: A systematic review of community based hepatitis C treatment.
abstract: BACKGROUND
  Hepatitis C virus (HCV) treatment uptake globally is low. A barrier to treatment is the necessity to attend specialists, usually in a tertiary hospital. We investigate the literature to assess the effect of providing HCV treatment in the community on treatment uptake and cure.
  
  
  METHODS
  Three databases were searched for studies that contained a comparison between HCV treatment uptake or sustained virologic response (SVR) in a community site and a tertiary site. Treatment was with standard interferon with or without ribavirin, or pegylated interferon and ribavirin. A narrative synthesis was conducted.
  
  
  RESULTS
  Thirteen studies fulfilled the inclusion criteria. Six studies measured treatment uptake; three demonstrated an increase in uptake at the community site, two demonstrated similar rates between sites and one demonstrated decreased uptake at the community site. Nine studies measured SVR; four demonstrated higher SVR rates in the community, four demonstrated similar SVR rates, and one demonstrated inferior SVR rates in the community compared to the tertiary site.
  
  
  CONCLUSIONS
  The data available supports the efficacy of HCV treatment in the community, and the potential for community based treatment to increase treatment uptake. Whilst further studies are required, these findings highlight the potential benefit of providing community based HCV care - benefits that should be realised as interferon-free therapy become available. (PROSPERO registration number CRD42015025505).
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Australia. amanda.wade@burnet.edu.au.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. amanda.wade@burnet.edu.au.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Wade
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Veronese
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.|Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Hellard
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Australia.|Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.|Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin
keywords: Community-based; Hepatitis C; Models of care; Opioid substitution; Treatment