BACKGROUND Treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) regimens has resulted in high rates of sustained virologic response (SVR). Treatment of vulnerable populations may be improved by incorporating an on-site intensive specialty pharmacy (ON-ISP). AIMS To describe outcomes of HCV treatment at a safety-net hospital and proportion of subjects achieving SVR for those using the ON-ISP compared to an off-site pharmacy (OFF-SP). METHODS A retrospective cohort study of 219 subjects treated for HCV with DAA at Boston Medical Center was conducted. Subject characteristics, virologic response, and pharmacy services used were recorded. We used multivariable logistic regression to test the association between ON-ISP and SVR after adjusting for covariates. RESULTS SVR occurred in 71% of subjects by intention-to-treat (73% among ON-ISP users vs 57% among OFF-SP users) and 95% completing treatment per-protocol (96% among ON-ISP users vs 87% among OFF-SP users). Adjustment for age, sex, ethnicity, insurance, fibrosis, prior treatment, and MELD revealed an increased likelihood of SVR among users of ON-ISP: OR 6.0 (95% CI 1.18-31.0). No significant difference in treatment delay or adverse events was seen among users of either pharmacy type. CONCLUSIONS HCV treatment with DAA was well tolerated, but the rate of SVR was low (71%) compared to trials. This was due to loss to follow-up, as the per-protocol rate of SVR was much higher (95%). Use of ON-ISP was associated with an increase in SVR and may be valuable for improving care for vulnerable populations.

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在一家安全网医院，重症药房改善了弱势患者人群的丙型肝炎治疗结果。

背景技术用直接作用抗病毒（DAA）方案治疗丙型肝炎病毒（HCV）导致持续病毒学应答（SVR）的发生率很高。通过合并现场密集的专业药房（ON-ISP），可以改善弱势人群的治疗。目的描述与非现场药房（OFF-SP）相比，使用ON-ISP进行安全网医院HCV治疗的结果以及达到SVR的受试者比例。方法在波士顿医学中心对219名接受DAA治疗的HCV患者进行了回顾性队列研究。记录受试者特征，病毒学应答和所用药房服务。调整协变量后，我们使用多变量logistic回归来测试ON-ISP和SVR之间的关联。结果按意愿进行治疗的受试者中有71％发生了SVR（ON-ISP用户中为73％，OFF-SP用户中为57％），按协议完成治疗的比例为95％（ON-ISP用户中为96％，而87％）非SP用户之间）。对年龄，性别，种族，保险，纤维化，既往治疗和MELD的调整显示ON-ISP用户中SVR的可能性增加：OR 6.0（95％CI 1.18-31.0）。两种药房的使用者在治疗延迟或不良事件方面均未见明显差异。结论DAA HCV治疗耐受性良好，但与试验相比，SVR率低（71％）。这是由于随访失败，因为SVR的每协议率要高得多（95％）。ON-ISP的使用与SVR的增加有关，可能对改善对弱势人群的护理很有价值。