Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada

Abstract

Background: Treatment of hepatitis c virus (HCV) with direct-acting-antivirals (DAAs) by family physicians in primary care and addiction settings may allow treatment expansion to inner-city populations, including people who inject drugs (PWID). Real-world data however, suggests high rates of non-attendance to SVR 12 testing. This study examines outcomes of HCV treatment delivered by family physicians working in interdisciplinary treatment programs, integrated into inner-city primary care clinics.

Methods: In this prospective cohort, participants completed baseline questionnaires, including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR 12) if HCV RNA was undetectable 12 weeks following end of therapy, and were recorded as lost to follow-up (LTFU) if they did not present for an HCV follow-up visit. SVR was calculated in intention to treat (ITT) as well as modified intention to treat (mITT) analysis, which excluded those who completed treatment but had no SVR 12 result. A logistic regression model assessed factors associated with LTFU.

Results: Of 138 individuals included in the analysis, 52% were on opioid agonist therapy (OAT), 75% reported a history of injection drug use (IDU), with 25% reporting IDU in the month prior to treatment initiation. ITT SVR across all sites and genotypes was 86% and mITT was 95%. There was a significant difference in mITT for those reporting recent IDU compared to those who did not (87% vs 99% p = 0.03). While 13% were LTFU at SVR 12, participants receiving OAT in the same clinic as HCV treatment were less likely to be LTFU (aOR 0.09(0.02-0.46)).

Conclusion: HCV treatment by family physicians, along with interdisciplinary teams, can be successful in inner-city populations in the era of DAAs; however, follow-up after treatment is a challenge. Integrating OAT in the same location as HCV treatment may help to improve follow-up.

Keywords: Daa; Hepatitis C; Injection drug use; Opioid agonist therapy; Primary care.