Abstract
BackgroundHepatitis 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.MethodsThree 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.ResultsThirteen 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.ConclusionThe 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).Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1548-5) contains supplementary material, which is available to authorized users.
Highlights
Hepatitis C virus (HCV) treatment uptake globally is low
To gain data that may inform HCV service delivery policy, we reviewed the literature to compare treatment uptake rates in community based treatment services with conventional tertiary services, and to compare sustained virological response (SVR) outcomes in patients treated with standard interferon with or without ribavirin, or pegylated interferon and ribavirin, in the community with patients treated in conventional tertiary settings
The interventions that resulted in HCV treatment provision in the community were diverse, and included; telehealth, integrated HCV services in opioid substitution therapy (OST) clinics or needle and syringe exchange program (NSEP) services, private medical practice and outreach services staffed by specialists or nurses
Summary
Hepatitis C virus (HCV) treatment uptake globally is low. Each year in Australia less than 2 % of people infected with hepatitis C virus (HCV) are treated and globally treatment uptake rates are low [1]. The HCV treatment landscape is changing; pegylated interferon, ribavirin and protease inhibitor regimens of 6–12 months duration, which generate serious adverse effects in about 10 % of people and achieve cure in. Increasing treatment accessibility may significantly improve HCV treatment uptake and cure, but a key issue is a lack of quality information about which model of care is most efficacious. As the new Australian model of care unfolds, it is timely to reflect upon the available evidence regarding hepatitis C treatment in the community
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