***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 BACKGROUND Direct-acting antiviral therapy ( DAAs ) for hepatitis C infection ( HCV ) have a much smaller burden of treatment than interferon-based regimes , require less monitoring and are very effective . New pathways are required to increase access to treatment amongst people prescribed opioid substitution therapy ( OST ) . METHODS An exploratory cluster r and omised controlled trial with mixed methods evaluation was undertaken to compare the uptake of  dried blood spot testing ( DBST ) and treatment of people with genotype 1 HCV infection in a conventional service pathway versus a pharmacist-led pathway in a population receiving OST . RESULTS Pharmacies r and omised to the conventional pathway obtained 58 DBST from 244 patients (24%):15 new reactive tests and 33 new negative tests were identified . Within the pharmacist-led pathway , 94 DBST were obtained from 262 patients ( 36 % ) : 26 new reactive tests and 54 new negative tests were identified . Participants in the pharmacist-led pathway were more likely to take a DBST ( p<0.003 ) . Of participants referred for treatment through the conventional pathway , 4 patients from 15 with new reactive tests ( 27 % ) attended clinic for assessment . In the pharmacist-led treatment pathway , 20 patients from 26 with new reactive tests ( 77 % ) attended for assessment blood tests . Participants in the pharmacist-led pathway were more likely to proceed through the assessment for treatment ( p<0.002 ) . One participant completed treatment through the conventional pathway and three patients completed treatment through the pharmacist-led pathway . The process evaluation identified key themes important to service user completers and staff participants . CONCLUSION The study provides evidence that testing and treatment for HCV in a pharmacist led-pathway is a feasible treatment pathway for people who receive supervised OST consumption through community pharmacies . This feasibility trial therefore provides sufficient confirmation to justify proceeding to a full trial OBJECTIVES To revise 2010 guidance on grading the strength of evidence ( SOE ) of the effectiveness of drugs , devices , and other preventive and therapeutic interventions in systematic review s produced by the Evidence -based Practice Center ( EPC ) program , established by the US Agency for Healthcare Research and Quality ( AHRQ ) . STUDY DESIGN AND SETTING A cross-EPC working group review ed authoritative systems for grading SOE [ primarily the approach from the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) working group ] and conducted extensive discussion s with GRADE and other experts . RESULTS Up date d guidance continues to be conceptually similar to GRADE . Review ers are to evaluate SOE separately for each major treatment comparison for each major outcome . We added reporting bias as a required domain and retained study limitations ( risk of bias ) , consistency , directness , and precision ( and three optional domains ) . Additional guidance covers scoring consistency , precision , and reporting bias , grading bodies of evidence with r and omized controlled trials and observational studies , evaluating single study bodies of evidence , using studies with high risk of bias , and presenting findings with greater clarity and transparency . SOE is grade d high , moderate , low , or insufficient , reflecting review ers ' confidence in the findings for a specific treatment comparison and outcome . CONCLUSION No single approach for grading SOE suits all review s , but a more consistent and transparent approach to reporting summary information will make review s more useful to the broad range of audiences that AHRQ 's work aims to reach . EPC working groups will consider ongoing challenges and modify guidance as needed , on issues such as combining trials and observational studies in bodies of evidence , weighting domains , and combining qualitative and quantitative syntheses BACKGROUND Though direct acting antivirals ( DAAs ) promise high cure rates , many providers and payers remain concerned about successful treatment for people who use drugs ( PWUD ) , even among those engaged in opioid agonist treatment ( OAT ) . The efficacy of DAAs among PWUD in real-world setting s is unclear . METHODS We conducted a cohort study of patients initiating HCV treatment between January 2014 and August 2015 ( n=89 ) at a primary care clinic in the Bronx , NY . Onsite HCV treatment with DAAs was performed by an HCV specialist , with support from a care coordinator funded by the NYC Department of Health . We identified four categories of drug use and drug treatment : ( 1 ) no active drug use/not receiving OAT ( defined as non-PWUD ) ; ( 2 ) no active drug use/receiving OAT ; ( 3 ) active drug use/not receiving OAT ; and ( 4 ) active drug use/receiving OAT . The primary outcome was SVR at 12 weeks post-treatment . RESULTS Overall SVR rates were 95 % ( n=41/43 ) for non-PWUD and 96 % ( n=44/46 ) for patients actively using drugs and /or receiving OAT [ p=0.95 ] . There were no differences in SVR rates by drug use or drug treatment category . Compared to non-PWUD , those with no active drug use/receiving OAT had 100 % SVR ( n=15/15 ; p=1.0 ) , those actively using drugs/not receiving OAT had 90 % SVR ( n=9/10 ; p=0.47 ) , and those actively using drugs/receiving OAT had 95 % SVR ( 20/21 ; p=1.0 ) . CONCLUSION Regardless of active drug use or OAT , patients who received DAA therapy at an urban primary care clinic achieved high HCV cure rates . We found no clinical evidence to justify restricting access to HCV treatment for patients actively using drugs and /or receiving OAT Introduction Hepatitis C virus ( HCV ) infection affects 0.7 % of the general population , and up to 40 % of people prescribed opioid substitution therapy ( OST ) in Scotl and . In conventional care , less than 10 % of OST users are tested for HCV and less than 25 % of these initiate treatment . Community pharmacists see this group frequently to provide OST supervision . This study examines whether a pharmacist-led ‘ test & treat ’ pathway increases cure rates for HCV . Methods and analysis This protocol describes a cluster-r and omised trial where 60 community pharmacies provide either conventional or pharmacy-led care .  All pharmacies offer dried blood spot testing ( DBST ) for HCV .  Participants have attended the pharmacy for OST for 3 months ; are positive for HCV genotype 1 or 3 ; are not co-infected with HIV and /or hepatitis B ; have no decompensated liver disease ; are not pregnant . For conventional care , pharmacists refer HCV-positive participants to a local centre for assessment . In the pharmacy-led arm , pharmacists assess participants themselves in the pharmacy . Drug prescribing is by nurse prescribers ( conventional arm ) or pharmacist prescribers ( pharmacy-led arm ) . Treatment in both arms is delivered as daily modified directly observed therapy in a pharmacy . Primary trial outcome is number of sustained virological responses at 12 weeks after treatment completion . Secondary trial outcomes are number of tests taken ; treatment uptake ; completion ; adherence ; re-infection . An economic evaluation will assess potential cost-effectiveness . Qualitative research interviews with clients and health professionals assess acceptability of a pharmacist-led pathway . Ethics and dissemination This protocol has been ethically approved by the East of Scotl and Research Ethics Committee 2 ( 15/ES/0086 ) and complies with the Declaration of Helsinki and principles of Good Clinical Practice . Caldicott guardian approval was given on 16 December 2016 to allow NHS Tayside to pass information to the cluster community pharmacies about the HCV test status of patients that they are seeing to provide OST supervision . NHS R&D approvals have been obtained from each health board taking part in the study . Informed consent is obtained before study enrolment and only anonymised data are stored in a secured data base , enabling an audit trail . Results will be su bmi tted to international peer- review ed journals and presented at international conferences . Trial registration number NCT02706223 ; Pre- results BACKGROUND To achieve the World Health Organization hepatitis C elimination targets , it is essential to increase access to direct acting antivirals ( DAAs ) - especially amongst people who inject drugs ( PWID ) . We aim ed to determine the effectiveness of providing DAAs in primary care compared with hospital-based specialist care . METHODS We r and omised PWID with hepatitis C attending primary care sites in Australia or New Zeal and to receive DAAs at their primary care site or local hospital ( st and ard of care ( SOC ) ) . The primary outcome was to determine if people treated in primary care had a non-inferior sustained virologic response at week 12 ( SVR12 ) rate compared to historical controls ( consistent with DAA trials at the time of study design ) ; secondary outcomes included comparison of treatment initiation , SVR12 rates , and the care cascade by study arm . RESULTS We recruited 140 participants and r and omised 136 ; 70 to primary care and 66 to SOC . The SVR12 rate ( 100 % , 95 % CI , 87.7 - 100 ) of people treated in primary care was non-inferior when compared to historical controls ( 85 % assumed ) . Intention to treat analysis revealed that the proportion of participants commencing treatment in primary care ( 75 % , 43/57 ) was significantly higher than in SOC ( 34 % , 18/53 ) ( p<0.001 ; RR 2.48 ; 95 % CI , 1.54 - 3.95 ) , and the proportion of participants with SVR12 was significantly higher in primary care compared to SOC ( 49 % , 28/57 and 30 % , 16/53 ) ( p=0.043 ; RR 1.63 ; 95 % CI,1.0 - 2.65 ) . CONCLUSION Providing hepatitis C treatment in primary care increases treatment uptake and cure . Approaches that increase treatment uptake amongst PWID will accelerate elimination strategies 
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ConclusionS ervices sited in community setting s 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 .