Treatment by general practitioners in primary care
The PBS listing of DAA medicines enables GPs to initiate HCV therapy in primary care, with the goal of substantially increasing the HCV treatment work- force. As noted above, GPs who are experienced in the treatment of chronic HCV infection may prescribe independently. GPs who are not experienced in the treatment of HCV are eligible to prescribe the new HCV medicines provided this is done in consultation with an experienced gastroenterologist, hepatologist or infectious diseases physician. The consultation process promotes GP prescribing and experience without the need for formal accreditation. The Pharmaceutical Benefits Advisory Committee (PBAC) has not defined “experienced”. It should include all practitioners who have previously been accredited as prescribers for HCV medicines. For interested practitioners who do not have experience in treating HCV, we recommend participation in a formal education session. Links to useful and complementary online resources are given in below in Box 1. Clinical experience should be gained by providing treatment “in consultation” for at least 10 people living with HCV infection. The 10 treatment courses should be completed through SVR before moving on to independent prescribing. Ideally, the treatments prescribed in consultation should occur with one specialist or unit to develop an ongoing working relationship. The PBS does not require formal accreditation.
For people living with HCV, receiving treatment in familiar environments with their trusted, accessible, long-term doctors removes an important barrier to treatment and will improve the cascade of care. Evidence from the IFN era supports the efficacy of GP-led treatment with remote specialist supervision. 7,8 Primary care-based treatment is suitable for most people living with HCV, in particular those with mild–moderate liver fibrosis. To support this, the availability and interpretation of simple tools for liver fibrosis assessment in the community will be very important. People with cirrhosis, complex comorbidities or other types of liver disease, or in whom first-line DAA therapy has failed, should still be referred for specialist care.
Box 1. Resources containing useful information about assessment, treatment, monitoring and adherence