Sustained Impact of Task-shifting HCV Treatment to Nonspecialist Providers: 5-Year Follow Up of the ASCEND Investigation.

Abstract

Background: Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) has ushered in an era of short-duration treatment with high effectiveness across varied patient populations. In the ASCEND investigation, treatment with DAA was efficacious when delivered by nonspecialist and specialist providers. However, long-term outcomes after initial treatment are unknown.

Objective: To determine the long-term outcomes after DAA treatment independently provided by nurse practitioners, primary care physicians, or specialist physicians using DAA therapy.

Design: Retrospective cohort study.

Setting: Twelve urban, federally qualified health centers in the District of Columbia.

Participants: A total of 551 patients treated for HCV in the ASCEND investigation (A Phase IV Pilot Study to Assess of Community-based Treatment Efficacy in Chronic Hepatitis C Monoinfection and Coinfection with HIV in the District of Columbia).

Interventions: None.

Measurements: Sustained viral response (SVR12), reinfection, retreatment, death.

Results: In this large sample of majority Black individuals receiving care at community-based centers, there was an initial 87% rate of SVR, and after 5 years of follow up, an additional 6.5% of participants were found to be cured. This included individuals originally lost to follow up whose subsequent testing confirmed SVR12, and those with successful retreatment after initial treatment failure. There was a 70% rate of testing for reinfection, with 2 identified reinfections. Treatment outcomes were not associated with original treating provider type.

Limitations: As a retrospective analysis, these findings are limited by the availability of data in the electronic medical record.

Conclusions: DAA is an effective treatment for HCV and can safely be prescribed by multiple provider types, with favorable long-term outcomes.