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Improving access to treatment for patients with chronic hepatitis C through outreach
Ahmed Mohamed Elsharkawy1, Carolyn Miller2, Andrea Hearn3
1Liver Unit, University Hospitals Birmingham, Birmingham, UK.
Insights
Outreach clinics for hepatitis C (HCV) significantly improved attendance rates among injecting drug users compared to hospital clinics. These clinics increased access to antiviral treatment for this marginalized population.
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Chronic hepatitis C infection (HCV) is prevalent among injecting drug users, posing a significant risk for liver disease.
- Antiviral treatments for HCV offer a cure but are often limited by side effects, monitoring requirements, and poor patient attendance at traditional healthcare settings.
- Low attendance rates at hospital appointments present a barrier to HCV treatment in this demographic.
Purpose of the Study:
- To evaluate the effectiveness of novel outreach clinics established in drug treatment centers for managing hepatitis C (HCV) in injecting drug users.
- To assess patient attendance, treatment initiation, and outcomes in patients referred to these specialized outreach clinics.
Main Methods:
- A retrospective service review was conducted on three outreach clinics located in drug treatment centers.
- Data collected included patient demographics, attendance rates, treatment initiation, and treatment outcomes.
- Comparison of attendance rates with traditional hospital-based clinics was performed.
Main Results:
- Outreach clinics achieved a 75% attendance rate, significantly higher than the 50% rate observed at hospital clinics.
- Of 141 referrals, 30% initiated HCV treatment, and 21% were in the process of workup or awaiting treatment.
- Sustained viral response was achieved in 13 out of 24 patients who completed treatment.
Conclusions:
- Establishing outreach clinics within drug treatment centers substantially enhances clinic attendance for hepatitis C (HCV) patients.
- These clinics improve access to essential HCV treatment for marginalized populations, including current and former injecting drug users.
- Outreach models demonstrate a viable strategy for increasing treatment uptake and improving health outcomes in hard-to-reach patient groups.
Background:
Chronic hepatitis C infection (HCV) is common in injecting drug users and is a major cause of liver disease. Antiviral treatment can 'cure' HCV, but is frequently associated with side effects and requires regular monitoring. Non-attendance at hospital appointments is frequent. To try and improve attendance and increase the number of current and previous injecting drug users treated we developed three outreach clinics.
Objective:
To review the outcome of patients referred to the outreach clinics.
Methods:
Retrospective service review of three clinics at drug treatment centres in Newcastle and Northumberland. Data was collected on attendance rates, patient demographics, treatment rates and outcomes.
Results:
141 referrals were received across the three sites with an overall attendance rate of 75% (106 patients, 79% men and median age 36), which compared favourably with that at our hospital (50%). All patients were on methadone/subutex. 45% were infected with Genotype 1 HCV. 10% were cirrhotic. To date, 30% have started treatment and 21% are waiting to start or are still in workup. 13% elected to delay treatment due to early stage disease and 11% were not ready for treatment on psychological or social grounds. Only 12% failed to attend follow up after initial assessment. To date, 24 patients have completed full courses of treatment with sustained viral response in 13 patients. Results are awaited for seven patients.
Conclusions:
The development of outreach clinics for HCV in drug treatment centres can substantially improve clinic attendance and increase access to treatment in this marginalised group.
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