***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Direct-acting antiviral ( DAA ) therapy for hepatitis C virus ( HCV ) infection has result ed in high rates of disease cure ; however , not enough specialists currently are available to provide care . Objective To determine the efficacy of HCV treatment independently provided by nurse practitioners ( NPs ) , primary care physicians ( PCPs ) , or specialist physicians using DAA therapy . Design Nonr and omized , open-label clinical trial initiated in 2015 . ( Clinical Trials.gov : NCT02339038 ) . Setting 13 urban , federally qualified health centers ( FQHCs ) in the District of Columbia . Patients A referred sample of 600 patients , of whom 96 % were black , 69 % were male , 82 % were treatment naive , and 20 % had cirrhosis . Seventy-two percent of the patients had HCV genotype 1a infection . The baseline characteristics of patients seen by each provider type were similar . Intervention Patients were assigned in a nonr and omized but specified manner to receive treatment from 1 of 5 NPs , 5 PCPs , or 6 specialists . All providers underwent an identical 3-hour training session based on guidelines . Patients received treatment with ledipasvir-sofosbuvir , which was provided on site , according to U.S. Food and Drug Administration labeling requirements . Measurements Sustained virologic response ( SVR ) . Results 516 patients achieved SVR  , a response rate of 86 % ( 95 % CI , 83.0 % to 88.7 % ) , with no major safety signals . Response rates were consistent across the 3 provider types : NPs , 89.3 % ( CI , 83.3 % to 93.8 % ) ; PCPs , 86.9 % ( CI , 80.6 % to 91.7 % ) ; and specialists , 83.8 % ( CI , 79.0 % to 87.8 % ) . Patient loss to follow-up was the major cause of non-SVR . Limitation Nonr and omized patient distribution ; possible referral bias . Conclusion In a real-world cohort of patients at urban FQHCs , HCV treatment administered by nonspecialist providers was as safe and effective as that provided by specialists . Nurse practitioners and PCPs with compact didactic training could substantially exp and the availability of community-based providers to escalate HCV therapy , bridging existing gaps in the continuum of care for patients with HCV infection . Primary Funding Source National Institutes of Health and Gilead Sciences AIMS To estimate adherence and response to therapy for chronic hepatitis C virus ( HCV ) infection among people with a history of injecting drug use . A secondary aim was to identify predictors of HCV treatment response . DESIGN Prospect i ve cohort recruited between 2009 and 2012 . Participants were treated with peg-interferon alfa-2a/ribavirin for 24 ( genotypes 2/3 , G2/3 ) or 48 weeks ( genotype 1 , G1 ) . SETTING Six opioid substitution treatment ( OST ) clinics , two community health centres and one Aboriginal community-controlled health organization providing drug treatment services in New South Wales , Australia . PARTICIPANTS Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse , 101 were assessed for treatment outcomes ( 21 % female ) . MEASUREMENTS Study outcomes were treatment adherence and sustained virological response ( SVR , undetectable HCV RNA > 24 weeks post-treatment ) . FINDINGS Among 101 treated , 37 % ( n = 37 ) had recently injected drugs ( past 6 months ) and 62 % ( n = 63 ) were receiving OST . Adherence ≥ 80 % was 86 % ( n = 87 ) . SVR was 74 % ( 75 of 101 ) , with no difference observed by sex ( males : 76 % , females : 67 % , P = 0.662 ) . In adjusted analysis , age < 35 ( versus ≥ 45 years ) [ adjusted odds ratio ( aOR ) = 5.06 , 95 % confidence interval ( CI ) = 1.47 , 17.40 ] and on-treatment adherence ≥ 80 % independently predicted SVR ( aOR = 19.41 , 95 % CI = 3.61 , 104.26 ] . Recent injecting drug use at baseline was not associated with SVR . CONCLUSIONS People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses  to interferon-based therapy similar to other population s , despite injecting drugs at baseline . Younger age and adherence are predictive of improved response to hepatitis C virus therapy BACKGROUND Among people who inject drugs ( PWID ) , the prevalence of hepatitis C virus ( HCV ) infection is high ; however HCV treatment uptake remains low . New models of care are needed to address the growing burden of HCV-related disease in PWID and to underst and the barriers to assessment and treatment of HCV . This study evaluated assessment and treatment for HCV infection among PWID attending an opioid substitution treatment ( OST ) clinic with an integrated peer support worker model . METHODS Clients with a history of IDU and chronic HCV infection , attending the Newcastle Pharmacotherapy Service , Newcastle Australia , were recruited as part of a multisite prospect i ve observational study ( the ETHOS Cohort ) . Additional chart review was conducted for clients not enrolled in the ETHOS Cohort . A peer support worker was introduced to complement and extend services offered by the clinical team . Client contacts and assessment s with a nurse and /or peer worker were evaluated , including those who commenced HCV treatment . RESULTS A total of 1447 clients attended the OST service during February 2009 and June 2014 . Of these , 378 ( 26 % ) were assessed by a nurse and 242 ( 17 % ) by a clinician . HCV treatment was commenced by 20 ( 5 % ) participants and 15 ( 75 % ) achieved a sustained virological response ( SVR ) . During May 2009 and July 2011 , 332 nurse contacts and 726 peer worker contacts were evaluated . The nurse-led contacts were related to HCV treatment ( 50 % ) and review of pathology tests ( 34 % ) , whereas peer worker contacts included discussion about HCV treatment ( 75 % ) , education , counselling and /or support ( 53 % ) and general discussion about HCV infection ( 59 % ) . CONCLUSION These data demonstrate that peer support workers facilitate broader discussion about HCV treatment , education and /or support , allowing nurses to focus on HCV-related assessment and treatment . HCV treatment uptake was very low in this cohort , but SVR was high . The integration of peer support workers in treatment programs within OST clinics may address barriers to HCV care , but further studies are needed to assess their impact on assessment and treatment outcomes Background : Hepatitis C virus ( HCV ) is a prevalent chronic blood-borne infection among opioid-dependent patients on methadone maintenance treatment ( MMT ) .  Despite case reports and case – control studies , a r and omized controlled trial ( RCT ) examining HCV treatment adherence in methadone-maintained patients is lacking and was the impetus for this ongoing RCT examining modified directly administered therapy for HCV treatment integrated within a MMT . Methods : Subjects were r and omized 1:1 to receive HCV treatment as modified directly observed therapy ( mDOT ) into the MMT program or at a liver specialty clinic as self-administered therapy ( SAT ) .  R and omization was stratified based on HIV status and HCV genotype . Results : Twenty-one subjects to date have enrolled in this pilot study . The mDOT subjects have had greater success in starting treatment and 10 of the 12 mDOT subjects achieved early virologic response ( EVR ) at week 12 and 6 of those 10 achieved sustained virologic response ( SVR ) . Of the nine SAT subjects , only three achieved EVR at week 12 and only one achieved SVR despite not completing the treatment . Conclusions : Hepatitis C treatment can be successfully integrated into a methadone maintenance clinic , and mDOT can be implemented with a methadone clinic ’s existing nursing and medical staff . Patients struggling with concurrent substance use and mental illness comorbidity may be successfully addressed in such setting s and facilitate access to and completion of treatment through the utilization of on-site clinical services for HCV treatment and adherence support with mDOT . The exact importance of site of services and adherence support remains a significant area for future investigation The aim of the present prospect i ve observational study was to assess uptake and success of hepatitis C virus ( HCV ) treatment among a group of former and current injection drug users with chronic HCV infection at the Street Health Centre in Kingston , Ontario . The Street Health Centre offers hepatitis C education , assessment and treatment within a multidisciplinary , integrated and collaborative treatment model of care delivered by primary care professionals . The study enrolled a convenience sample of 34 patients . Seventy per cent of study patients had no post secondary education , 85 % were unemployed and one-third were unstably housed . A majority of study patients self-reported mental health problems . Of the 14 patients who initiated antiviral treatment in the study period , eight ( 57 % ) achieved sustained virological response . Regardless of virological outcome , patients who initiated treatment showed positive trends toward increased social and psychiatric stability , and decreases in high-risk behaviours . These results suggest that not only is successful treatment of chronic HCV infection in current and former injection drug users with concurrent psychiatric disorders possible , but the benefits of such treatment delivered in a community-based , multidisciplinary , primary care model may extend beyond narrowly defined virological outcomes BACKGROUND Access to hepatitis C virus ( HCV ) treatment remains extremely limited among people who inject drugs ( PWID ) .  HCV assessment and treatment was evaluated through an innovative model for the provision of HCV care among PWID with chronic HCV infection . METHODS Enhancing Treatment for Hepatitis C in Opioid Substitution Setting s ( ETHOS ) was a prospect i ve observational cohort . Recruitment was through 5  opioid substitution treatment ( OST ) clinics , 2 community health centers , and 1 Aboriginal community controlled health organization in New South Wales , Australia . RESULTS Among 387 enrolled participants , mean age was 41 years , 71 % were male , and 15 % were of Aboriginal ethnicity .  Specialist assessment  was undertaken in 191 ( 49 % ) participants , and 84 ( 22 % ) commenced interferon-based treatment . In adjusted analysis , HCV specialist assessment was associated with non-Aboriginal ethnicity ( adjusted odds ratio [ AOR ] , 4.02 ; 95 % confidence interval [ CI ] , 2.05 - 7.90 ) , no recent benzodiazepine use ( AOR , 2.06 ; 95 % CI , 1.31 - 3.24 ) , and non-1 HCV genotype ( AOR , 2.13 ; 95 % CI , 1.32 - 3.43 ) . In adjusted analysis , HCV treatment was associated with non-Aboriginal ethnicity ( AOR , 4.59 ; 95 % CI , 1.49 - 14.12 ) , living with the support of family and /or friends ( AOR , 2.15 ; 95 % CI , 1.25 - 3.71 ) , never receiving OST ( AOR , 4.40 ; 95 % CI , 2.27 - 8.54 ) , no recent methamphetamine use ( AOR , 2.26 ; 95 % CI , 1.12 - 4.57 ) , and non-1 HCV genotype ( AOR , 3.07 ; 95 % CI , 1.67 - 5.64 ) . CONCLUSIONS HCV treatment uptake was relatively high among this highly marginalized population of PWID . Potentially modifiable factors associated with treatment include drug use and social support BACKGROUND An estimated 250,000 Canadians are infected with the hepatitis C virus ( HCV ) . The present study describes a cohort of individuals with HCV referred to community-based , integrated prevention and care projects developed in British Columbia . Treatment outcomes are reported for a subset of individuals undergoing antiviral therapy  at four project sites . METHODS Four demonstration projects based on a public health nurse and physician partnership were established in rural and small urban centres in British Columbia . Comprehensive medical assessment s determined whether individuals received treatment , or counselling and education . Outcomes of the treatment group were compared with published r and omized controlled trials . Client demographics were mapped using geographical information systems applications . RESULTS A total of 1795 individuals were referred to the clinics for medical assessment between September 2001 and December 2005 . After assessment , 26 % were eligible for therapy , while 74 % received counselling and education .  Wait times decreased annually , with one-half of all referrals assessed within 30 days . Combination antiviral therapy was initiated in 363 clients with interferon plus ribavirin ( n=36 ) or pegylated interferon plus ribavirin ( n=327 ) . Treatment outcomes were available for 205 individuals . The overall rate of sustained virological response was 61 % ( 126 of 20 
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Patient reported experiences included trusted and supportive care providers , safe and trusted services , easily accessible care , and positive psychological and behavioural changes .