The Road To Hepatitis C Elimination: A Change In Care Pathway Increases Access To Hepatitis C Treatment For People On Opiate Substitution Therapy

Author: Stephens BP, Tait JM, Ahmad F, Dillon JF

Theme: Models of Care Year: 2018

To achieve HCV elimination more people must have access to treatment. With direct acting
antiviral (DAA) therapies, the opportunity exists to remove many of the pre-treatment
investigations and review appointments previously required before treatment could safely be
initiated. By removing these barriers the aim was to facilitate a greater number of people
onto treatment, specifically for those receiving Opiate substitution therapies (OST).
From August 2017 our treatment pathway was revised to reduce the assessment burden.
Patients could now have a single set of liver tests and a Fib4 score calculated to assess the
likely extent of liver disease. Those with no evidence of liver cirrhosis could advance to
treatment prescribed by Specialist Nursing Staff, avoiding 3 further appointments for
Fibroscan, liver ultrasound and a Medical Practitioners review.
Retrospective analysis of the data on those treated between September 2016 to March 2017
and the subsequent year, indicate an increase in treatment numbers from 92 to 164. This
included an increase of over 100% in patients in receipt of OST in an outreach setting where
the transmission route is known to be intravenous drug use.
Individuals on opiate substitution therapy can find it challenging to progress through
traditional pathways due to the complex and time consuming assessment process.
Simplification of the pathway has resulted in 70% of patients being able to access immediate
treatment and the numbers treated in outreach drug services significantly increased from the
previous time period. This highlights the efficiency of the new pathway. Follow up SVR data
on both cohorts will be available in the coming months.
Disclosure of Interest Statement:
B Stephens has received honoraria for lectures from Janssen, Gilead and MSD.
J Tait has received honoraria for lectures from Abbvie, Gilead, BMS and MSD.
JF Dillon has honoraria for lectures & research grants from Janssen-Cilag, Roche, Merck
Sharp & Dohme, AbbVie, Bristol-Myers Squibb & Gilead.

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