A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments

Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (S...

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Bibliographic Details
Published in:	BMC health services research Vol. 19; no. 1; p. 765
Main Authors:	Radley, Andrew, Robinson, Emma, Aspinall, Esther J, Angus, Kathryn, Tan, Lex, Dillon, John F
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 28-10-2019 BioMed Central BMC
Subjects:	Antiviral agents Antiviral Agents - therapeutic use Biological response modifiers Community Health Services - statistics & numerical data Diagnosis Direct acting antiviral drugs Drugs Drugstores Health Services Research Hepatitis C Hepatitis C - diagnosis Hepatitis C - drug therapy Hepatitis C virus Humans Interferon Mass Screening - statistics & numerical data Medical research Medical testing products Pharmacy Primary care Primary Health Care - statistics & numerical data Randomized Controlled Trials as Topic Ribavirin Risk factors Systematic review Telemedicine Direct acting antiviral drugs Systematic review Hepatitis C Primary care
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Summary:	Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	1472-6963 1472-6963
DOI:	10.1186/s12913-019-4635-7