Comparison of hepatitis C treatment outcomes between primary care and specialty care

Area of Science:

• Hepatology
• Infectious Diseases
• Primary Care Medicine

Background:

• Hepatitis C virus (HCV) infections have surged in the US, disproportionately affecting aging baby boomers.
• The increasing prevalence of HCV strains pressure the medical system, highlighting a shortage of specialist providers.
• This necessitates exploring alternative, accessible treatment settings.

Purpose of the Study:

• To compare the efficacy of direct-acting antiviral treatment for Hepatitis C in primary care versus specialist settings.
• To determine if cure rates are equivalent between primary care and specialty care for HCV patients.
• To assess the feasibility of expanding HCV treatment into primary care.

Main Methods:

• A retrospective cohort study design was employed.
• Participants included HCV patients treated by specialists (gastroenterologists/hepatologists) and in primary care community health centers.
• Multivariate logistic regression analyzed sustained virologic response rates, combining treatment failure and loss to follow-up.

Main Results:

• Primary care treatment failure rates were 4%, compared to 1.1% in specialty care.
• After adjustment, primary care patients were statistically less likely to experience treatment failure or be lost to follow-up.
• Hepatitis C treatment outcomes in primary care were found to be equivalent to those in specialist care.

Conclusions:

• Primary care settings, particularly with advanced practice nurses, are well-suited for identifying and treating Hepatitis C.
• Enhanced patient engagement in primary care may lead to improved follow-up rates compared to specialist referrals.
• Expanding HCV treatment into primary care can improve access and outcomes for a growing patient population.