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dc.contributor.authorRadley, Andrewen_UK
dc.contributor.authorRobinson, Emmaen_UK
dc.contributor.authorAspinall, Esther Jen_UK
dc.contributor.authorAngus, Kathrynen_UK
dc.contributor.authorTan, Lexen_UK
dc.contributor.authorDillon, John Fen_UK
dc.description.abstractBackground Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. Methods Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). Results Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). Conclusion Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.en_UK
dc.publisherSpringer Science and Business Media LLCen_UK
dc.relationRadley A, Robinson E, Aspinall EJ, Angus K, Tan L & Dillon JF (2019) A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments. BMC Health Services Research, 19, Art. No.: 765.
dc.rightsThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.en_UK
dc.subjectHepatitis Cen_UK
dc.subjectSystematic reviewen_UK
dc.subjectDirect acting antiviral drugsen_UK
dc.subjectPrimary careen_UK
dc.titleA systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatmentsen_UK
dc.typeJournal Articleen_UK
dc.citation.jtitleBMC Health Services Researchen_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.contributor.affiliationGlasgow Caledonian Universityen_UK
dc.contributor.affiliationInstitute for Social Marketingen_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.description.refREF Compliant by Deposit in Stirling's Repositoryen_UK
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles

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