Integrating Hepatitis C Care for opioid substitution treatment patients attending general practice: Feasibility, Clinical and Cost Effectiveness (Preprint)

2021 ◽  
Author(s):  
Geoff McCombe ◽  
Davina Swan ◽  
John S Lambert ◽  
Eileen O’Connor ◽  
Zoe Ward ◽  
...  
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
Complex Intervention ◽  
Substitution Treatment ◽  
Hcv Treatment ◽  
Post Intervention ◽  
Opioid Substitution Treatment ◽  
Clinical Support ◽  
Opioid Substitution

BACKGROUND Hepatitis C (HCV) infection is common among people who inject drugs (PWID), yet well described barriers mean that a minority have accessed HCV treatment. OBJECTIVE The aim of this study was to examine feasibility, acceptability, clinical and cost effectiveness of an integrated model of HCV care for opioid substitution treatment (OST) patients in general practice. METHODS A pre-and-post intervention design with an embedded economic analysis was used to establish the feasibility, acceptability, clinical and cost effectiveness of a complex intervention to optimise HCV identification and linkage to HCV treatment among patients prescribed methadone in primary care. The ‘complex intervention’ comprised General Practitioner (GP) / practice staff education, nurse-led clinical support, and enhanced community-based HCV assessment of patients. General practices in North Dublin were recruited from the professional networks of the research team and from GPs who attended educational sessions. RESULTS Fourteen practices, 135 patients participated. Follow-up data was collected six-months post-intervention on 131(97.0%) patients. With regards to clinical effectiveness, among HCV antibody-positive patients, there was a significant increase in the proportions of who had a liver fibroscan (17/101(16.8%) vs 52/100 (52.0%); p<0.001), had attended hepatology/infectious diseases services (51/101(50.5%) vs 61/100 (61.0%); p=0.002), and initiated treatment (20/101(19.8%) vs 30/100 (30.0%); p=0.004). The mean incremental cost-effectiveness ratio of the intervention was €13,255 per quality adjusted life year gained at current full drug list price (€39,729 per course), which would be cost saving if these costs are reduced by 88%. CONCLUSIONS The complex intervention involving clinical support, access to assessment and practitioner education has the potential to enhance patient care, improving access to assessment and treatment in a cost effective manner.

scholarly journals Hepatitis C testing and status among opioid substitution treatment clients in New South Wales

2014 ◽  
Vol 38 (2) ◽  
pp. 160-164 ◽  
Author(s):  
Fiona L. Shand ◽  
Carolyn Day ◽  
William Rawlinson ◽  
Louisa Degenhardt ◽  
Nicholas G. Martin ◽  
...  
Keyword(s):  
Hepatitis C ◽  
New South ◽  
New South Wales ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
South Wales ◽  
Opioid Substitution

scholarly journals Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (11) ◽  
pp. e0166451 ◽  
Author(s):  
Håvard Midgard ◽  
Jørgen G. Bramness ◽  
Svetlana Skurtveit ◽  
John W. Haukeland ◽  
Olav Dalgard
Keyword(s):  
Hepatitis C ◽  
Population Based ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Population Based Study ◽  
Hepatitis C Treatment ◽  
Treatment Uptake ◽  
Opioid Substitution

Hepatitis C Virus Prevalence and Incidence in a Large Nationwide Sample of Patients in Opioid Substitution Treatment in Germany: A Prospective Cohort Study

2019 ◽  
Vol 70 (10) ◽  
pp. 2199-2205 ◽  
Author(s):  
Bernd Schulte ◽  
Christiane Sybille Schmidt ◽  
Lisa Strada ◽  
Moritz Rosenkranz ◽  
Ingo Schäfer ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
High Risk ◽  
Incidence Rates ◽  
Hcv Rna ◽  
High Risk Population ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Hcv Antibody ◽  
Opioid Substitution

Abstract Background Hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs (PWID). Accurate data on HCV prevalence and incidence rates among patients receiving opioid substitution treatment (OST) are needed to estimate the current and future burden of HCV infections in this high-risk population. Methods Baseline data from routine care were collected between October 2014 and June 2016 from randomly selected OST facilities in Germany. The primary outcome measure was the HCV status (antibody and RNA prevalence). Patients who were HCV antibody–negative at baseline were followed up after 12 months to calculate the HCV incidence rate. Results Sixty-three facilities from 14 German Federal States provided clinical data for a total of 2466 OST patients. HCV antibody and HCV RNA prevalence were 58.8% (95% confidence interval [CI], 56.8%–60.8%) and 27.3% (95% CI, 25.5%–29.2%), respectively. At baseline, a total of 528 patients (21.4%) had previously undergone antiviral treatment. Moreover, lower HCV RNA prevalence was associated with female gender, employment, younger age, and shorter duration of OST and opioid dependence. The HCV incidence rate was 2.5 cases per 100 person-years. Conclusions The low HCV RNA prevalence and HCV incidence rates confirm that OST in Germany is an effective setting both for treating chronic HCV infections and for preventing new infections among PWID. Scaling up the provision of OST, HCV testing, and HCV treatment among OST patients are important public health strategies for reducing HCV infections in this high-risk population.

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