Task-Shifting: An Approach to Decentralized Hepatitis C Treatment in Medically Underserved Areas

• Published in: Digestive diseases and sciences 2015-12, Vol.60 (12), p.3552-3557
• Main Authors: Jayasekera, Channa R., Perumpail, Ryan B., Chao, David T., Pham, Edward A., Aggarwal, Avin, Wong, Robert J., Ahmed, Aijaz
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis; Antiviral agents; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Biochemistry; Biological products industry; California; Drug therapy; Female; Gastroenterology; Health Services Accessibility; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Hepatology; Humans; Male; Medical research; Medically Underserved Area; Medically uninsured persons; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Practical nurses; Retrospective Studies; Ribavirin - administration & dosage; Ribavirin - therapeutic use; Simeprevir - administration & dosage; Simeprevir - therapeutic use; Sofosbuvir - administration & dosage; Sofosbuvir - therapeutic use; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-015-3911-6

Background Despite the availability of safe and effective direct-acting antiviral drugs (DAAs), the vast majority of patients with chronic hepatitis C (HCV) in the USA remain untreated, in part due to lack of access to specialist providers. Aims To determine the effectiveness of DAA-based treatment in medically underserved areas in California, in a healthcare model dependent on task-shifting—wherein a visiting hepatologist assesses patients for treatment eligibility, but subsequent routine follow-up evaluation of patients prescribed treatment is devolved to a part-time licensed vocational nurse under remote supervision of the hepatologist. Methods We retrospectively determined rates of sustained virologic response 12 weeks after treatment completion (SVR-12), adverse events, and treatment discontinuations in patients who received sofosbuvir-based DAA regimens between December 2013 and November 2014. Results Despite limited specialist provider involvement in medically underserved areas, all but two of 58 patients completed treatment, and 88 % of patients achieved the curative endpoint of undetectable HCV RNA 12 weeks after completing treatment (sustained virologic response, SVR-12). Almost 80 % of patients with cirrhosis and 85 % of patients with prior treatment experience achieved SVR-12. Conclusions Treatment effectiveness with sofosbuvir-based regimens in medically underserved areas utilizing task-shifting from a specialist to a mid-level provider is comparable to those achieved in pivotal clinical trials for these regimens, and to “real-world” experiences of tertiary care centers in the USA.