1. HCV treatment by nurse practitioners and primary care physicians with compact didactic training was found to be equally as effective as specialist treatment.
2. Nonspecialist provider HCV treatment could help address current gaps in care and increase patients receiving therapy.
Evidence Rating Level: 2 (Good)
Study Rundown: Despite the emergence of direct-acting antiviral (DAA) therapy, an effective treatment for hepatitis C virus (HCV) infection, patients face many barriers to acquiring treatment. For example, of the 43% of patients aware of their HCV diagnosis, only 16% are currently being treated. One solution to the challenge of widespread HCV treatment is training nonspecialists to deliver HCV therapy. The authors of this study were interested in determining the efficacy of HCV DAA treatment provided by nonspecialists, including nurse practitioners (NPs) and primary care physicians (PCPs), compared to specialist physicians. This study has several limitations. First, the primary outcome for this study did not address long-term outcomes, such as surveillance for hepatocellular carcinoma or reinfection. Patient distribution was also nonrandomized. Overall, the results of this study indicate that nonspecialists can provide effective and safe treatment for HCV patients. By increasing the number of community-based providers, more patients may be able to receive HCV treatment.
In-Depth [nonrandomized clinical trial]: The authors conducted a nonrandomized, open-label clinical trial. The primary outcome of the trial was sustained virologic response (SVR). In total, 600 patients were included in the study, where they were assigned in a nonrandom manner to receive treatment from a NP, PCP, or a specialist. Here, the treatment was ledipasvir-sofosbuvir. Overall, 86% of patients responded to treatment and achieved SVR (95%CI 83.0% to 88.7%), where similar results were observed for nonspecialist and specialist cohorts. Additionally, no major safety concerns were observed during the trial. In total, 98 participants had adverse events, of which 98% were grade 1 or grade 2.
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