A nurse practitioner model of care in the era of direct acting antiviral therapy for hepatitis C virus infection.

BACKGROUND AND AIM

Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection has resulted in high rates of successful disease cure; however, not enough healthcare providers are available to deliver treatment to the population living with chronic HCV. To demonstrate that a nurse practitioner (NP) model of care is non-inferior to specialist gastroenterologist (SG) management of HCV infection, as measured by sustained viral response at 12 weeks (SVR) after initiation of DAA therapy.

DESIGN

Retrospective cohort database study.

SETTING

Single-center outpatient study, Central Coast Local Health District (CCLHD).

PARTICIPANTS

All patients with chronic HCV treated in the CCLHD Liver Clinic in the period 3rd March 2016 to 31st May 2019 were retrospectively analyzed. In this time period, a total of 1638 patients with chronic HCV had completed treatment. Seven hundred and thirty-four patients were excluded (733 pre-PBS listing for DAAs and 1 not treated with DAA). Nine hundred and four patients were eligible for the study, of which 541 were managed by an SG, and 363 managed by an NP.

MAIN OUTCOME MEASURES

Data were collected on patient demographics, genotype, fibrosis score, and presence of cirrhosis. Primary end point was number of patients achieving SVR.

RESULTS

Of the 904 patients treated with DAA, 764 (84.5%) achieved SVR. There was no statistical difference ( > 0.05) in achieving SVR between patients treated by an SP ( = 481, 88.9%) and those treated by an NP ( = 281, 77.4%).

CONCLUSION

An NP model of care is non-inferior to SG management of HCV infection, as evidenced by equivocal success in achieving SVR between the two treatment groups. Therefore, an NP model of care is a viable option in the era of DAA therapy for HCV infection. Ongoing investment into the delivery of NP care could increase treatment uptake of HCV, with the aim of decreasing overall burden of disease.