title: Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment.
abstract: BACKGROUND
  Chronic hepatitis C is common in people who inject drugs (PWID) and this population serves as a reservoir for infection. Treatment levels are low among this group, ranging from 1 to 19%. We explored whether a nurse-initiated community treatment model increased uptake of and adherence to interferon-based therapies.
  
  
  METHODS
  This was a cluster randomized trial of nurse-initiated versus physician-initiated antiviral therapy with pegylated interferon and ribavirin for hepatitis C virus in community clinics (trial registration: ISRCTN07774040).
  
  
  RESULTS
  The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each arm not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy.
  
  
  CONCLUSIONS
  Despite easy access to antiviral therapy, uptake of treatment was poor, with no significant difference between the groups. Nurse-led initiation of interferon-based antiviral therapy in PWID did not lead to increased uptake of, response to or adherence with treatment. Further service improvement is unlikely to increase the proportion of PWID undergoing antiviral therapy for hepatitis C virus and early adoption of interferon-free regimens may increase the proportion initiating and completing treatment.
authors.affiliation: aDepartment of Gastroenterology, Frimley Health Foundation Trust, Surrey bHepatology Unit, Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London cBlood Borne Virus Team, Tower Hamlets Specialist Addiction Unit, East London NHS Foundation Trust, Beaumont House, Mile End Hospital, London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Lewis
authors.forename: Jan
authors.initials: J
authors.lastname: Kunkel
authors.forename: David
authors.initials: D
authors.lastname: Axten
authors.forename: Jane
authors.initials: J
authors.lastname: Dalton
authors.forename: Hayley
authors.initials: H
authors.lastname: Gardner
authors.forename: Andrew
authors.initials: A
authors.lastname: Tippett
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wynne
authors.forename: Mandie
authors.initials: M
authors.lastname: Wilkinson
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003152:Community Health Nursing / Q000458:organization & administration*; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000451:nursing* / Q000635:transmission; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a