(P-284) High Adherence and Sustained Virologic Response Among Vulnerable People Initiating an Hcv Treatment at a Community-based Nurse-led Clinic: A Cohort Study

Background: Hepatitis C virus (HCV) triggers a global pandemic. Effective treatments are available and can cure HCV infection in most patients. However, adherence remains suboptimal in vulnerable people (90% of HCV-infected individuals in high-income countries). There is a need to develop specific care route for vulnerable people, yet actual community-based interventions have failed to effectively prevent the transmission of HCV in this population. A nurse-led model of care, whereby nurses consolidate a network of outreach services for vulnerable people, could bridge this gap.

Objectives: At a community-based nurse-led clinic, we aimed to: (1) report the prevalence of patients initiating an HCV treatment who (a) achieved sustained virologic response (SVR) and (b) were adherent to their treatment; and (2) explore factors associated with adherence and SVR.

Methods: In this prospective cohort study, we included all individuals who initiated an HCV treatment at a nurse-led clinic (Quebec, Canada), from Jan 1, 2012 to Dec 31, 2017. Variables were abstracted from patient records. “SVR” was achieved if HCV RNA was undetectable or below the lower limit of quantification at week 12 or later. Patients who reported HCV treatment completion without missing any doses were considered as “adherent.” We used working Poisson regression to identify factors associated with adherence and SVR, and calculated adjusted prevalence ratios (aPRs) with 95% confidence intervals (95%CIs).

Results: A total of 171 patients infected with HCV (women: n=51, 30%; criminal record: n=102, 60%; substance addiction: n=99, 58%) initiated an HCV treatment at the nurse-led clinic during the study period. Overall, 126/171 (74%) patients were adherent. Patients using illicit drugs were less likely to be adherent, compared to nonusers (aPR=0.77, 95%CI: 0.67-0.89). Those with HCV treatment length of 48 weeks were also less likely to be adherent, compared to those with HCV treatment length of 8 or 12 weeks (aPR=0.29, 95%CI: 0.09-0.94). Among 156/171 (91%) patients with an HCV RNA test post-treatment, 96% (n=149) achieved SVR. Compared to patients who were adherent, those who were non-adherent were less likely to achieve SVR (aPR=0.81, 95%CI: 0.68-0.98). Compared to patients without a criminal record, those having a criminal record were less likely to achieve SVR (aPR=0.87, 95%CI: 0.79-0.97).

Conclusions: Our findings suggest that a community-based nurse-led clinic could fill an important gap in HCV health services targeted at vulnerable people, to drive adherence and SVR achievement in this population.