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 H, Hugh and Verma, Sumita (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. ISSN 1478-3223

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Abstract

Background/aims: Direct acting antivirals (DAA) 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 HCV screening/treatment in people who use drugs (PWUD).
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 liver-specific (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 percent 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 in those with SVR: SFLDQoL (symptoms, memory, distress, loneliness, hopelessness, sleep and stigma) (p</= 0.011); SF-12 v2 physical and mental health domains (p<0.001); and EQ-5D-5L composite profile score (p= 0.009) and visual analogue scale, p<0.001. Cost (British pounds 2018) per case detected was £171; mean cost per cure (excluding medication) was £702 + 188.
Conclusions: Excellent real-world SVRs in PWUD with significant improvement in HRQoL can be achieved at modest costs. Project ITTREAT endorses community-based integrated services to help achieve HCV elimination.

Item Type: Article
Keywords: sustained virological response, patient reported outcomes, health economics, reinfection, HCV elimination
Schools and Departments: Brighton and Sussex Medical School > Clinical and Experimental Medicine
Subjects: R Medicine > R Medicine (General)
Depositing User: Sumita Verma
Date Deposited: 07 Feb 2020 10:23
Last Modified: 28 Jul 2020 12:01
URI: http://sro.sussex.ac.uk/id/eprint/89786

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Project NameSussex Project NumberFunderFunder Ref
ITTREATUnsetGilead SciencesUnset
ITTREATUnsetBrighton and Hove CommissionersUnset