Caitlyn Stulpin , 2025-04-18 16:29:00
April 18, 2025
2 min read
Key takeaways:
- The ASCEND trial assessed patient outcomes by provider type and found no significant differences.
- A 5-year follow-up showed high rates of SVR and retreatment, with minimal reinfection.
A 5-year follow-up of the ASCEND study demonstrated increased rates of SVR, high rates of retesting and minimal reinfection among patients with hepatitis C virus regardless of provider type.
“We wanted to understand the long-term outcomes of hepatitis C after direct acting antiviral (DAA) treatment, and to evaluate if these outcomes differ by the original treating provider type,” Sarah Kattakuzhy, MD, MPH, associate professor in the Institute of Human Virology at the University of Maryland School of Medicine, told Healio.
A 5-year follow up of the ASCEND investigation demonstrated that primary outcomes did not differ by provider type, and at least 90% of patients treated by each of the assessed provider types were cured. Image: Adobe Stock.
To do so, Kattakuzhy and colleagues conducted a retrospective cohort study during which they assessed 551 patients treated for HCV at 12 health centers in the District of Columbia as part of the ASCEND investigation.
ASCEND was initially conducted in 2015 to determine whether patient outcomes differed when care was provided by three different provider types — nurse practitioners, primary care physicians or infectious disease/gastroenterology specialists.
For the updated study assessing long-term outcomes, the researchers reevaluated these patients for SVR, reinfection, retreatment and death. The researchers then looked at rates of each outcome by provider type.
Overall, the researchers determined 97.5% of patients had sustained SVR — 87% from the initial ASCEND study and an additional 6.5% who were cured after 5 years of follow up.
Additionally, they found that there was a 70% rate of testing for reinfection. Among these, 45% were tested in the first year after SVR and were not tested again and 41% had at least one assessment for reinfection 3 or more years after SVR with nearly 10% testing 5 years after SVR.
Through this testing, two reinfections were identified. According to the study, one reinfected patient was subsequently treated and cured a second time.
In the 5 years after the initial ASCEND study, 25 patients died — five from HCV-related causes such as hepatocellular carcinoma and decompensated cirrhosis. The researchers did not know the cause of death for 14 of these patients.
Overall, the study revealed that the primary outcomes did not differ by provider type — at least 90% of patients treated by each of the three provider types were cured. The researchers also found that there was no significant difference in the number of patients who were retreated, reinfected or died from an HCV-related cause when assessed by provider type.
Based on these findings, Kattakuzhy concluded that decentralized care of HCV to nonspecialist providers is “supported by long term favorable outcomes.”
“We continue to face an epidemic of hepatitis C, exacerbated in the context of the opioid crisis,” she said. “Expanding curative treatment is imperative and administrative barriers that impede this progress should be eliminated.”
For more information:
Sarah Kattakuzhy, MD, MPH, can be reached at SKattakuzhy@ihv.umaryland.edu.