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.