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ITTREAT (Integrated Community Test ‐ Stage ‐ TREAT) Hepatitis C service for people who use drugs: Real‐world outcomes

O'Sullivan, Margaret, Jones, Anna‐Marie, Gage, Heather, Jordan, Jake, MacPepple, Ekelechi, Williams, Hugh, Verma, Sumita and Dore, Gregory (2020) ITTREAT (Integrated Community Test ‐ Stage ‐ TREAT) Hepatitis C service for people who use drugs: Real‐world outcomes Liver International, 40 (5). pp. 1021-1031.

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Abstract

Background/aims: Direct-acting antivirals (DAAs) provide an unprecedented opportunity for a “find-and-treat strategy.” We aimed to report real-world clinical, patient reported and health economic outcomes of community-based hepatitis C virus (HCV) screening/treatment in people who use drugs (PWUDs). Methods: Project ITTREAT (2013-2021), established at a drug and alcohol treatment centre, offered a comprehensive service. Generic (SF-12v2 and EQ-5D-5L) and liverspecific (SFLDQoL) health-related quality of life (HRQoL) were assessed before and after HCV treatment. Costs/case detected and cured were calculated. Primary outcome measure was sustained virological response (SVR) (intention to treat). Results: Till March 2018, 573 individuals recruited, 462 (81%) males, mean age 40.5 ± 10.0 years. Of the 125 treated, 115 (92%) had past/current history of injecting drug use, 88 (70%) were receiving opioid agonist treatment and 50 (40%) were homeless. Twenty-six per cent received interferon-based and 74% DAA-only regimens. SVR (ITT) was 87% (90% with DAAs). Service uptake/HCV treatment completion rates were >95%, HCV reinfection being 2.63/100 person years (95% CI 0.67-10.33). HRQoL improved significantly at end of treatment (EOT) in those with SVR: SFLDQoL (symptoms, memory, distress, loneliness, hopelessness, sleep and stigma) (P</ = .011); SF-12 v2 physical and mental health domains (P < .001); and EQ-5D-5L composite profile score (P = .009) and visual analogue scale, P < .001. Cost (British pounds 2018) per case detected was £171; mean cost per cure (excluding medication) was £702 ± 188. Conclusions: Excellent real-world SVRs in PWUDs with significant improvement in HRQoL can be achieved at modest costs. Project ITTREAT endorses communitybased integrated services to help achieve HCV elimination.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
O'Sullivan, Margaret
Jones, Anna‐Marie
Gage, HeatherH.Gage@surrey.ac.uk
Jordan, Jakejake.jordan@surrey.ac.uk
MacPepple, Ekelechie.macpepple@surrey.ac.uk
Williams, Hugh
Verma, Sumita
Dore, Gregory
Date : 12 February 2020
DOI : 10.1111/liv.14403
Copyright Disclaimer : © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Depositing User : James Marshall
Date Deposited : 05 Jun 2020 15:36
Last Modified : 05 Jun 2020 15:36
URI: http://epubs.surrey.ac.uk/id/eprint/857098

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