Can antiviral treatment for hepatitis C be safely and effectively delivered in primary care?

Authors: Brew, Iain F¹; Butt, Christine²; Wright, Nat³

Source: British Journal of General Practice, Volume 63, Number 617, December 2013 , pp. e842-e851(10)

Publisher: Royal College of General Practitioners

Abstract:

Background

The burden of hepatitis C (HCV) treatment is growing, as is the political resolve to tackle the epidemic. Primary care will need to work more closely with secondary care to succeed in reducing the prevalence of chronic HCV.

Aim

To identify research relating to the provision of antiviral treatment for HCV in primary care.

Design and setting

A narrative systematic review of six databases.

Method

Medline, Embase, Cinahl, PsycINFO, Web of Science, and Cochrane were searched. Relevant journals were searched by hand for articles to be included in the review. Reference lists of relevant papers were reviewed and full-text papers were retrieved for those deemed to potentially fulfil the inclusion criteria of the review.

Results

A total of 683 abstracts led to 77 full-text articles being retrieved, of which 16 were finally included in the review. An evidence base emerged, highlighting that community-based antiviral treatment provision is feasible and can result in clinical outcomes comparable to those achieved in hospital outpatient settings. Such provision can be in mainstream general practice, at community addiction centres, or in prisons. GPs must be trained before offering such a service and there is also a need for ongoing specialist supervision of primary care practice. Such training and supervision can be delivered by teleconference, although, even with such ready availability of training and supervision, only a minority of GPs are likely to want to provide antiviral treatment.

Conclusion

There is emerging evidence supporting the effectiveness of antiviral treatment provision for patients with chronic hepatitis C in a wide variety of primary care and wider community settings. Training and ongoing supervision of primary care practitioners by specialists is a prerequisite. There is an opportunity through future research activity to evaluate typologies of patients who would be best served by primary care-based treatment and those for whom hospital-based outpatient treatment would be most appropriate.

Keywords: general practice; hepatitis C; pegylated interferon; primary care; ribavirin

Document Type: Research Article

DOI: http://dx.doi.org/10.3399/bjgp13X675421

Affiliations: 1: In hepatitis C; Clinical director of Leeds Prison Healthcare Department, HMP Leeds, Leeds. 2: Clinical research fellow, Clinical director of Leeds Prison Healthcare Department, HMP Leeds, Leeds. 3: Clinical director of Leeds Prison Healthcare Department, HMP Leeds, Leeds.

Publication date: December 2013

Source