combined community drug recovery and hepatitis c treatment ......cirrhosis •different care pathway...
TRANSCRIPT
Combined community drug recovery and hepatitis C treatment clinic
Dr Lee Middleton
Glasgow Alcohol and Drug Recovery Service
Background
• OST clinics in Govan
• Average caseload of 200
• Regular HCV testing (uptake >98%)
• Approx. 1/3 active HCV
Problem
• Poor engagement with available hospital based treatment service
• Chronic, untreated HCV
• How to increase engagement with assessment?
• How to increase treatment?
The plan
• Offer one-stop drug recovery service and HCV treatment clinic
• Work collaboratively with hospital services to ensure continuity of care
• Maintain engagement with a view to quick assessment/treatment
Staff
• Two addiction nurses
• Senior HCV addiction nurse
• Medical officer
• Hospital clinical nurse specialist
• Third sector HCV support service
Interventions
• Liver assessments
• Fibroscans
• Direct-acting antiviral (DAA) medication
• OST
• Harm reduction
• Befriending and HCV 1:1 support
Interventions
Results HCV Clinic (%) Hospital (%) Overall (%) p-value
Allocated 35 (47.3) 39 (52.7) 74 (100)
Gender M/F 29/6 (82.9M) 26/13 (66.7M) 55/19 (74.3M)
Treatment
completed
18 (51.4) 9 (23.1) 27 (36.5) 0.011
Continuing
engagement
16 (45.7) 8 (20.5) 24 (32.4) <0.001
Untreated/
disengaged
0 (0) 15 (38.7) 15 (20.3) <0.001
Deceased 1 (2.9) 7 (17.9) 8 (10.8) 0.036
Cirrhosis
• Different care pathway involving consultant review
• 24 patients found to have cirrhosis
• 12 allocated to each clinic
• Combined clinic – all treated or continued engagement
• Hospital services – 3 treated/engaged, 7 disengaged, 2 deceased
Drug use
HCV Clinic (%) Hospital (%) p-value
Treatment completed 18 9
Reported drug use pre-
treatment
14 (77.8) 5 (55.6) 0.234
Reported reduced/no drug
use during treatment
13/14 (92.8) 0/5 (0) <0.001
Maintained reduced/no
drug use 3 months post
treatment
6/13 (46.2) n/a
Conclusion
• Combined clinic more effective than traditional care model
• Reduction in all cause mortality
• Reduced drug use, sustained post-treatment
• Easily to replicate
