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Montgomery MP, Randall LM, Morrison M, Gupta N, Doshani M, Teshale E. Hepatitis C Cascades: Data to Inform Hepatitis C Elimination in the United States. Public Health Rep 2023:333549231193508. [PMID: 37667621 DOI: 10.1177/00333549231193508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
The United States has a goal to eliminate hepatitis C as a public health threat by 2030. To accomplish this goal, hepatitis C virus (HCV) care cascades (hereinafter, HCV cascades) can be used to measure progress toward HCV elimination and identify disparities in HCV testing and care. In this topical review of HCV cascades, we describe common definitions of cascade steps, review the application of HCV cascades in health care and public health settings, and discuss the strengths and limitations of data sources used. We use examples from the Massachusetts Department of Public Health as a case study to illustrate how multiple data sources can be leveraged to produce HCV cascades for public health purposes. HCV cascades in health care settings provide actionable data to improve health care quality and delivery of services in a single health system. In public health settings at jurisdictional and national levels, HCV cascades describe HCV diagnosis and treatment for populations, which can be challenging in the absence of a single data source containing complete, comprehensive, and timely data representing all steps of a cascade. Use of multiple data sources and strategies to improve interoperability of health care and public health data systems can advance the use of HCV cascades and speed progress toward HCV elimination.
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Affiliation(s)
- Martha P Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Now with Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Liisa M Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - Monica Morrison
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - Neil Gupta
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lilhore UK, Manoharan P, Sandhu JK, Simaiya S, Dalal S, Baqasah AM, Alsafyani M, Alroobaea R, Keshta I, Raahemifar K. Hybrid model for precise hepatitis-C classification using improved random forest and SVM method. Sci Rep 2023; 13:12473. [PMID: 37528148 PMCID: PMC10394001 DOI: 10.1038/s41598-023-36605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/07/2023] [Indexed: 08/03/2023] Open
Abstract
Hepatitis C Virus (HCV) is a viral infection that causes liver inflammation. Annually, approximately 3.4 million cases of HCV are reported worldwide. A diagnosis of HCV in earlier stages helps to save lives. In the HCV review, the authors used a single ML-based prediction model in the current research, which encounters several issues, i.e., poor accuracy, data imbalance, and overfitting. This research proposed a Hybrid Predictive Model (HPM) based on an improved random forest and support vector machine to overcome existing research limitations. The proposed model improves a random forest method by adding a bootstrapping approach. The existing RF method is enhanced by adding a bootstrapping process, which helps eliminate the tree's minor features iteratively to build a strong forest. It improves the performance of the HPM model. The proposed HPM model utilizes a 'Ranker method' to rank the dataset features and applies an IRF with SVM, selecting higher-ranked feature elements to build the prediction model. This research uses the online HCV dataset from UCI to measure the proposed model's performance. The dataset is highly imbalanced; to deal with this issue, we utilized the synthetic minority over-sampling technique (SMOTE). This research performs two experiments. The first experiment is based on data splitting methods, K-fold cross-validation, and training: testing-based splitting. The proposed method achieved an accuracy of 95.89% for k = 5 and 96.29% for k = 10; for the training and testing-based split, the proposed method achieved 91.24% for 80:20 and 92.39% for 70:30, which is the best compared to the existing SVM, MARS, RF, DT, and BGLM methods. In experiment 2, the analysis is performed using feature selection (with SMOTE and without SMOTE). The proposed method achieves an accuracy of 41.541% without SMOTE and 96.82% with SMOTE-based feature selection, which is better than existing ML methods. The experimental results prove the importance of feature selection to achieve higher accuracy in HCV research.
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Affiliation(s)
- Umesh Kumar Lilhore
- Department of Computer Science and Engineering, Chandigarh University, Gharuan, Mohali, Punjab, 140413, India
| | - Poongodi Manoharan
- College of Science and Engineering, Qatar Foundation, Hamad Bin Khalifa University, Doha, Qatar.
| | - Jasminder Kaur Sandhu
- Department of Computer Science and Engineering, Chandigarh University, Gharuan, Mohali, Punjab, 140413, India
| | - Sarita Simaiya
- Apex Institute of Technology (CSE), Chandigarh University, Gharuan, Mohali, Punjab, 140413, India
| | - Surjeet Dalal
- Amity School of Engineering and Technology, Amity University Haryana, Gurugram, India
| | - Abdullah M Baqasah
- Department of Information Technology, College of Computers and Information Technology, Taif University, Taif, 21974, Saudi Arabia
| | - Majed Alsafyani
- Department of Computer Science, College of Computers and Information Technology, Taif University, P. O. Box 11099, Taif, 21944, Saudi Arabia
| | - Roobaea Alroobaea
- Department of Computer Science, College of Computers and Information Technology, Taif University, P. O. Box 11099, Taif, 21944, Saudi Arabia
| | - Ismail Keshta
- Computer Science and Information Systems Department, College of Applied Sciences, AlMaarefa University, Riyadh, Saudi Arabia
| | - Kaamran Raahemifar
- College of Information Sciences and Technology, Data Science and Artificial Intelligence Program, Penn State University, State College, PA, 16801, USA
- School of Optometry and Vision Science, Faculty of Science, University of Waterloo, 200 University, Waterloo, ON, N2L3G1, Canada
- Faculty of Engineering, University of Waterloo, 200 University Ave W, Waterloo, Canada
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Rigg J, Doyle O, McDonogh N, Leavitt N, Ali R, Son A, Kreter B. Finding undiagnosed patients with hepatitis C virus: an application of machine learning to US ambulatory electronic medical records. BMJ Health Care Inform 2023; 30:bmjhci-2022-100651. [PMID: 36639190 PMCID: PMC9843171 DOI: 10.1136/bmjhci-2022-100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/04/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS To develop and validate a machine learning (ML) algorithm to identify undiagnosed hepatitis C virus (HCV) patients, in order to facilitate prioritisation of patients for targeted HCV screening. METHODS This retrospective study used ambulatory electronic medical records (EMR) from January 2015 to February 2020. A Gradient Boosting Trees algorithm was trained using patient records to predict initial HCV diagnosis and was validated on a temporally independent held-out cross-section of the data. The fold improvement in precision (proportion of patients identified by the algorithm who are HCV positive) over universal screening was examined and compared with risk-based screening. RESULTS 21 508 positive (HCV diagnosed) and 28.2M unlabelled (lacking evidence of HCV diagnosis) patients met the inclusion criteria for the study. After down-sampling unlabelled patients to aid the algorithm's learning process, 16.2M unlabelled patients entered the analysis. Performance of the algorithm was compared with universal screening on the held-out cross-section, which had an incidence of HCV diagnoses of 0.02%. The algorithm achieved a 101.0 ×, 18.0 × and 5.1 × fold improvement in precision over universal screening at 5%, 20% and 50% levels of recall. When compared with risk-based screening, the algorithm required fewer patients to be screened and improved precision. CONCLUSIONS This study presents strong evidence towards the use of ML on EMR data for the prioritisation of patients for targeted HCV testing with potential to improve efficiency of resource utilisation, thereby reducing the workload for clinicians and saving healthcare costs. A prospective interventional study would allow for further validation before use in a clinical setting.
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Affiliation(s)
- John Rigg
- AI for Healthcare & MedTech, IQVIA Inc, London, UK
| | - Orla Doyle
- AI for Healthcare & MedTech, IQVIA Inc, London, UK
| | | | - Nadea Leavitt
- AI for Healthcare & MedTech, IQVIA, Plymouth Meeting, Pennsylvania, USA
| | - Rehan Ali
- AI for Healthcare & MedTech, IQVIA Inc, London, UK
| | - Annie Son
- Medical Affairs, Gilead Sciences Inc, Foster City, California, USA
| | - Bruce Kreter
- Medical Affairs, Gilead Sciences Inc, Foster City, California, USA
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Strategy for the Micro-Elimination of Hepatitis C among Patients with Diabetes Mellitus-A Hospital-Based Experience. J Clin Med 2021; 10:jcm10112509. [PMID: 34204064 PMCID: PMC8200977 DOI: 10.3390/jcm10112509] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
Hepatitis C virus (HCV) infection can induce insulin resistance, and patients with diabetes mellitus (DM) have a higher prevalence of HCV infection. Patient outcomes improve after HCV eradication in DM patients. However, HCV micro-elimination targeting this population has not been approached. Little is known about using electronic alert systems for HCV screening among patients with DM in a hospital-based setting. We implemented an electronic reminder system for HCV antibody screening and RNA testing in outpatient departments among patients with DM. The screening rates and treatment rates at different departments before and after system implementation were compared. The results indicated that the total HCV screening rate increased from 49.3% (9505/19,272) to 78.2% (15,073/19,272), and the HCV-RNA testing rate increased from 73.4% to 94.2%. The anti-HCV antibody seropositive rate was 5.7%, and the HCV viremia rate was 62.7% in our patient population. The rate of positive anti-HCV antibodies and HCV viremia increased with patient age. This study demonstrates the feasibility and usefulness of an electronic alert system for HCV screening and treatment among DM patients in a hospital-based setting.
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Baer A, Fagalde MS, Drake CD, Sohlberg EH, Barash E, Glick S, Millman AJ, Duchin JS. Design of an Enhanced Public Health Surveillance System for Hepatitis C Virus Elimination in King County, Washington. Public Health Rep 2020; 135:33-39. [PMID: 31835010 DOI: 10.1177/0033354919889981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION With the goal of eliminating hepatitis C virus (HCV) as a public health problem in Washington State, Public Health-Seattle & King County (PHSKC) designed a Hepatitis C Virus Test and Cure (HCV-TAC) data system to integrate surveillance, clinical, and laboratory data into a comprehensive database. The intent of the system was to promote identification, treatment, and cure of HCV-infected persons (ie, HCV care cascade) using a population health approach. MATERIALS AND METHODS The data system automatically integrated case reports received via telephone and fax from health care providers and laboratories, hepatitis test results reported via electronic laboratory reporting, and data on laboratory and clinic visits reported by 6 regional health care systems. PHSKC examined patient-level laboratory test results and established HCV case classification using Council of State and Territorial Epidemiologists criteria, classifying patients as confirmed if they had detectable HCV RNA. RESULTS The data enabled PHSKC to report the number of patients at various stages along the HCV care cascade. Of 7747 HCV RNA-positive patients seen by a partner site, 5377 (69%) were assessed for severity of liver fibrosis, 3932 (51%) were treated, and 2592 (33%) were cured. PRACTICE IMPLICATIONS Data supported local public heath surveillance and HCV program activities. The data system could serve as a foundation for monitoring future HCV prevention and control programs.
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Affiliation(s)
- Atar Baer
- Public Health-Seattle & King County, Seattle, WA, USA
| | | | | | | | | | - Sara Glick
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alexander J Millman
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffrey S Duchin
- Public Health-Seattle & King County, Seattle, WA, USA.,Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, USA.,School of Public Health, University of Washington, Seattle, WA, USA
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García F, Domínguez-Hernández R, Casado M, Macías J, Téllez F, Pascasio JM, Casado MÁ, Alados JC. The simplification of the diagnosis process of chronic hepatitis C is cost-effective strategy. Enferm Infecc Microbiol Clin 2019; 37:634-641. [PMID: 30982677 DOI: 10.1016/j.eimc.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/22/2019] [Accepted: 03/01/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND The cascade of care of the hepatitisC are complex. The diagnosis of active infection in the same serum sample would simplify the process establishing a rapid access for patients to treatment. Our objective was to estimate the impact on healthcare and economic outcomes of the diagnosis of chronic infection in one-step diagnosis compared to standard diagnosis in Andalusia (8.39 million people). METHODS A decision tree was developed to estimate the referral of patients with chronic infection, loss of follow-up, access to treatment and costs of the diagnosis of the infection, for both processes. The unit costs (€, 2018) of the health resources (medical visits, antibodies, viral load and genotype), without considering the pharmacological cost, were obtained form public sources in Andalusia. RESULTS Of the total estimated population (269,526 patients), 1,389 patients would be referred to the specialised care in the one-step diagnosis and 1,063 in de standard diagnosis, being treated 1,320 and 1,009, respectively. In one-step diagnosis, no negative viral loud patient would be referred to specialist versus 540 with standard diagnosis. One-step diagnosis would generate a cost saving of €184,928 versus standard diagnosis (€15,671,493 vs €15,856,421). When compared one-step diagnosis to standard diagnosis, the savings per patient with positive viral load referred to specialist would be €3,634 (€11,279 vs €14,923). CONCLUSION The one-step diagnosis will achieve an increase in diagnosed patients, will increase the access of chronic patient to treatment and will generate cost savings, demonstrating its efficiency in the system in Andalusia.
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Affiliation(s)
- Federico García
- Unidad de Gestión Clínica de Microbiología Clínica, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Granada, España.
| | | | - Marta Casado
- Departamento de Gastroenterología, Complejo Hospitalario Torrecárdenas, Almería, España
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, España
| | - Francisco Téllez
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Puerto Real, Puerto Real, Cádiz, España
| | - Juan Manuel Pascasio
- Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, España
| | | | - Juan Carlos Alados
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
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Kushner T, Terrault NA. Hepatitis C in Pregnancy: A Unique Opportunity to Improve the Hepatitis C Cascade of Care. Hepatol Commun 2019; 3:20-28. [PMID: 30619991 PMCID: PMC6312659 DOI: 10.1002/hep4.1282] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Hepatitis C has increasingly affected women of child-bearing age over the past few years as a result of the opioid epidemic. In this review, we discuss the effect of hepatitis C on pregnancy outcomes, effect of pregnancy on hepatitis C, as well as implications on management of hepatitis C during pregnancy.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Norah A. Terrault
- Division of GastroenterologyUniversity of California San FranciscoSan FranciscoCA
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