Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment

• Published in: European journal of gastroenterology & hepatology Vol. 28; no. 11; p. 1258
• Main Authors: Lewis, Heather, Kunkel, Jan, Axten, David, Dalton, Jane, Gardner, Hayley, Tippett, Andrew, Wynne, Stephanie, Wilkinson, Mandie, Foster, Graham R
• Format: Journal Article
• Language: English
• Published: England 01.11.2016
• Subjects: Adult; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Community Health Nursing - organization & administration; Drug Therapy, Combination; Female; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - nursing; Hepatitis C, Chronic - transmission; Humans; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Male; Medication Adherence - statistics & numerical data; Middle Aged; Polyethylene Glycols - adverse effects; Polyethylene Glycols - therapeutic use; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Ribavirin - adverse effects; Ribavirin - therapeutic use; Substance Abuse, Intravenous - complications; Treatment Outcome
• ISSN: 1473-5687
• DOI: 10.1097/MEG.0000000000000711

Chronic hepatitis C is common in people who inject drugs (PWID) and this population serves as a reservoir for infection. Treatment levels are low among this group, ranging from 1 to 19%. We explored whether a nurse-initiated community treatment model increased uptake of and adherence to interferon-based therapies. This was a cluster randomized trial of nurse-initiated versus physician-initiated antiviral therapy with pegylated interferon and ribavirin for hepatitis C virus in community clinics (trial registration: ISRCTN07774040). The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each arm not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy. Despite easy access to antiviral therapy, uptake of treatment was poor, with no significant difference between the groups. Nurse-led initiation of interferon-based antiviral therapy in PWID did not lead to increased uptake of, response to or adherence with treatment. Further service improvement is unlikely to increase the proportion of PWID undergoing antiviral therapy for hepatitis C virus and early adoption of interferon-free regimens may increase the proportion initiating and completing treatment.