Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island

Ann Hepatol. Sep-Oct 2017;16(5):749-758. doi: 10.5604/01.3001.0010.2757.

Abstract

Introduction: The availability of curative hepatitis C therapies has created an opportunity to improve delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation.

Material and methods: Using a community based prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: 1) Treatment effectiveness using intention-to-treat analysis; and 2) Patient treatment experience assessed using demographics, adverse events, and medication adherence.

Results: During the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses.

Conclusion: In conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.

Keywords: Direct-acting antivirals; Health plan implementation; Hepatitis C virus; Real-world; SVR.

Publication types

  • Observational Study
  • Duplicate Publication

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Databases, Factual
  • Drug Costs
  • Female
  • Financing, Government*
  • Health Care Costs*
  • Health Services Accessibility
  • Hepatitis C, Chronic / diagnosis
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / economics
  • Hepatitis C, Chronic / virology
  • Humans
  • Intention to Treat Analysis
  • Male
  • Medication Adherence
  • Middle Aged
  • Prince Edward Island
  • Program Evaluation
  • Prospective Studies
  • Sustained Virologic Response
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome
  • Young Adult

Substances

  • Antiviral Agents