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275 CAPACITY ENHANCEMENT OF HEPATITIS C (HCV) TREATMENT THROUGH INTEGRATED COMMUNITY-BASED CARE WD Hill, G Butt, M Alvarez, M Krajden The aims of this study were to describe a collaborative practice and a cohort of individuals with HCV referred to integrated prevention and care projects developed in British Columbia (BC), and to report on treatment outcomes for a subset of individuals undergoing antiviral therapy.
Hepatitis Services Division, BC Centre for Disease Control, Vancouver, British Columbia
Four demonstration projects were established in rural and small urban centres in BC to provide locally-accessible, integrated hepatitis prevention and care services based on a public health nursing and physician collaborative practice. Comprehensive medical assessments determined whether individuals were eligible for treatment or received counseling and education. Outcomes of the treatment group were compared with published outcomes from randomized control trials. Client demographics were mapped using Geographic Information Systems applications to determine catchment area and access to the clinics.
From Sep 2001 to Dec 2005, a total of 1795 individuals were referred for comprehensive medical assessment to one of four clinics. Following assessment, 26% were eligible for therapy and 74% received counseling and education. The number of referrals, assessments, and clients initiating therapy increased rapidly during the first 3 years of clinic operations. Wait times decreased annually, with half of all referrals assessed within 30 days. The majority of nursing time (5273 hrs) was devoted to telephone calls (2099 hrs, 40%), client assessment (1242 hrs, 24%) and patient education (666 hrs, 13%). Physician time (1163 hrs) was equally divided between initial medical assessments (597 hrs, 51%) and follow-up office visits (524 hrs, 45%). Combination antiviral therapy with conventional or pegylated interferon plus ribavirin was initiated in 363 clients but because this is an ongoing cohort, treatment outcomes were available for 205 individuals on an intent-to-treat basis. The overall rate of sustained virological response (SVR) was 61% (126/205). For Genotype 1 (n=98), and 2 and 3 (n=107), the rate of SVR was 48% and 74%, respectively. The number of individuals assessed at each site represented, on average, 20% of the total cumulative reported HCV cases in each project catchment area.
The study findings illustrate how collaborative practice can service a population with complex medical needs while simultaneously increasing local capacity. These data indicate that a collaborative approach to the prevention and care of HCV was effective in rural and small urban settings and produced treatment outcomes comparable to published clinical trials.