Integrated Hepatitis C Care for People Who Inject Drugs (Heplink): Protocol for a Feasibility Study in Primary Care

Geoff McCombe; Davina Swan; Eileen O'Connor; Gordana Avramovic; Peter Vickerman; Zoe Ward; Julian Surey; Juan Macías; John S Lambert; Walter Cullen

doi:10.2196/resprot.9043

Integrated Hepatitis C Care for People Who Inject Drugs (Heplink): Protocol for a Feasibility Study in Primary Care

JMIR Res Protoc. 2018 Jun 4;7(6):e149. doi: 10.2196/resprot.9043.

Authors

Affiliations

¹ School of Medicine, University College Dublin, Dublin, Ireland.
² Centre for Research in Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
³ School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
⁴ Institute of Global Health, University College London, London, United Kingdom.
⁵ Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Seville, Spain.

Abstract

Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Drug use remains the significant cause of new infections in the European Union, with estimates of HCV antibody prevalence among people who inject drugs ranging from 5% to 90% in 29 European countries. In Ireland and the European Union, primary care is a key area to focus efforts to enhance HCV diagnosis and treatment among people who inject drugs.

Objective: The Heplink study aims to improve HCV care outcomes among opiate substitution therapy (OST) patients in general practice by developing an integrated model of HCV care and evaluating its feasibility, acceptability, and likely efficacy.

Methods: The integrated model of care comprises education of community practitioners, outreach of an HCV-trained nurse into general practitioner (GP) practices, and enhanced access of patients to community-based evaluation of their HCV disease (including a novel approach to diagnosis, that is, Echosens FibroScan Mini 430). A total of 24 OST-prescribing GP practices were recruited from the professional networks and databases of members of the research consortium. Patients were eligible if they are aged ≥18 years, on OST, and attend the practice for any reason during the recruitment period. Baseline data on HCV care processes and outcomes were extracted from the clinical records of participating patients.

Results: This study is ongoing and has the potential to make an important impact on patient care and provide high-quality evidence to help GPs make important decisions on HCV testing and onward referral.

Conclusions: A substantial proportion of HCV-positive patients on OST in general practice are not engaged with specialist hospital services but qualify for direct-acting antiviral drugs treatment. The Heplink model has the potential to reduce HCV-related morbidity and mortality.

Registered report identifier: RR1-10.2196/9043.

Keywords: general practice; hepatitis C; opiate substitution treatment; primary health care.

©Geoff McCombe, Davina Swan, Eileen O’Connor, Gordana Avramovic, Peter Vickerman, Zoe Ward, Julian Surey, Juan Macías, John S Lambert, Walter Cullen. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 04.06.2018.