Abstract
BackgroundHepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Drug use remains the significant cause of new infections in the European Union, with estimates of HCV antibody prevalence among people who inject drugs ranging from 5% to 90% in 29 European countries. In Ireland and the European Union, primary care is a key area to focus efforts to enhance HCV diagnosis and treatment among people who inject drugs.ObjectiveThe Heplink study aims to improve HCV care outcomes among opiate substitution therapy (OST) patients in general practice by developing an integrated model of HCV care and evaluating its feasibility, acceptability, and likely efficacy.MethodsThe integrated model of care comprises education of community practitioners, outreach of an HCV-trained nurse into general practitioner (GP) practices, and enhanced access of patients to community-based evaluation of their HCV disease (including a novel approach to diagnosis, that is, Echosens FibroScan Mini 430). A total of 24 OST-prescribing GP practices were recruited from the professional networks and databases of members of the research consortium. Patients were eligible if they are aged ≥18 years, on OST, and attend the practice for any reason during the recruitment period. Baseline data on HCV care processes and outcomes were extracted from the clinical records of participating patients.ResultsThis study is ongoing and has the potential to make an important impact on patient care and provide high-quality evidence to help GPs make important decisions on HCV testing and onward referral.ConclusionsA substantial proportion of HCV-positive patients on OST in general practice are not engaged with specialist hospital services but qualify for direct-acting antiviral drugs treatment. The Heplink model has the potential to reduce HCV-related morbidity and mortality.Registered Report IdentifierRR1-10.2196/9043
Highlights
With approximately 71 million people affected worldwide and 399,000 related deaths, chronic hepatitis C virus (HCV) infection is associated with considerable morbidity, including cirrhosis and hepatocellular carcinoma [1]
Injecting drug use remains the significant cause of new infections in the European Union, with estimates of HCV antibody prevalence among people who inject drugs (PWID) ranging from 5% to 90% in 29 European countries [2]
Our recent experience recruiting general practices [28,29] has taught us the importance of a researcher promptly following up an expression of interest from a general practitioner (GP) to fully explain the study and highlight what will be required from the GP in terms of time and commitment to the study
Summary
Hepatitis C as a Global ChallengeWith approximately 71 million people affected worldwide and 399,000 related deaths, chronic hepatitis C virus (HCV) infection is associated with considerable morbidity, including cirrhosis and hepatocellular carcinoma [1]. Developed HCV direct-acting antiviral drugs are well tolerated and delivered for shorter courses (8-12 weeks), with trials reporting more than 90% cure rates among PWID [6] Despite these highly effective and simplified therapeutic regimens, many people at risk are unaware of their infection, and obstacles limit access to HCV care, resulting in many patients not being treated [7]. Notwithstanding these challenges, the World Health Organization has set a goal of eliminating viral hepatitis as a major public health threat by 2030, reducing new chronic infections by 90% and reducing mortality by 65% [8].
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