Objectives

Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) has excellent cure rates and minimal side effects. Despite the high burden of disease, strategies to ultimately eradicate HCV are being developed. However, the delivery of care in regional settings is challenging and the efficacy of decentralised models of care is incompletely defined.

Methods

A prospective cohort study of patients whose treatment was initiated or supervised by Cairns Hospital, a tertiary hospital which provides services to a culturally diverse population across a 380,748 km² area in regional Australia. Patients' demographics, clinical features, DAA regimens and outcomes were recorded and correlated with their ensuing clinical course.

Results

Over 22 months, 734 patients were prescribed DAA therapy for HCV. No patients were prescribed interferon. Sofosbuvir/ledipasvir (n=371, 50.5%) and sofosbuvir/daclatasvir (n=287, 39.1%) were the most commonly prescribed regimens. No patients ceased treatment due to adverse effects. There were 612/734 (83.4%) patients with complete results, with 575 (94%) cured. At the end of the study period, there were 50 (6.8%) patients lost to follow-up and 72 (9.8%) awaiting SVR12 testing. The presence of cirrhosis (n=147/612, 24.1%) did not impact significantly on SVR12 rates, this being achieved in 136/147 (92.5%) cirrhotic patients versus 440/465 (94.6%) in non-cirrhotic patients (p=0.34). Treatment-experienced patients (95/612, 18.3%) were more likely to be non-responders than treatment-naïve patients (10/95 (10.5%) versus 26/517 (5%), p=0.04). Strategies to facilitate treatment included a dedicated clinical nurse consultant, education to primary health care providers, specialist outreach clinics to regional communities and shared care with general practitioners. SVR12 rates were similar amongst gastroenterologists (283/306, 92.5%), general practitioners (152/161, 94.4%), sexual health physicians (104/106, 98.1%) and other prescribers (37/39, 94.9%).

Conclusions

This study confirms that decentralised, multidisciplinary models of care can provide HCV treatment in regional and remote settings with excellent outcomes.

中文翻译：

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分散，多学科的护理模式促进了澳大利亚地区丙型肝炎的治疗

目标

丙型肝炎病毒（HCV）的直接作用抗病毒（DAA）治疗具有出色的治愈率，且副作用极小。尽管疾病负担很大，但正在制定最终消除HCV的策略。但是，在地区环境中提供医疗服务具有挑战性，并且分散式医疗服务模式的功效尚未完全定义。

方法

由凯恩斯医院（这是一家三级医院）发起或监督治疗的患者的前瞻性队列研究，该服务为澳大利亚地区380,748 km ²区域中的多元文化人群提供服务。记录患者的人口统计学，临床特征，DAA方案和结局，并将其与随后的临床过程相关联。

结果

在22个月内，有734例患者接受了DAA治疗HCV。没有患者开过干扰素处方。Sofosbuvir / ledipasvir（n = 371，50.5 ％）和sofosbuvir / daclatasvir（n = 287，39.1 ％）是最常用的治疗方案。没有患者因不良反应而停止治疗。有612/734（83.4％）例患者获得了完整的结果，其中575例（94％）得到了治愈。在研究结束时，有50（6.8％）位患者失去随访，有72位（9.8％）患者等待SVR12测试。肝硬化的存在（n = 147 / 612，24.1％）对SVR12的发生率没有显着影响，这在136/147（92.5％）的肝硬化患者中达到了，而在非肝硬化的患者中达到了440/465（94.6％）（p= 0.34）。有治疗经验的患者（95 / 612，18.3％）比没有治疗的患者（10/95（10.5％）对26/517（5％），无应答）更有可能无反应（p = 0.04）。促进治疗的策略包括专门的临床护士顾问，对初级卫生保健提供者的教育，对区域社区的专科门诊以及与全科医生共享护理。肠胃病医师（283/306，92.5％），全科医生（152/161，94.4％），性健康医师（104/106，98.1％）和其他处方者（37/39，94.9％）中SVR12的发生率相似。

结论

这项研究证实，分散的，多学科的护理模式可以在区域和偏远地区提供HCV治疗，并具有出色的疗效。