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Rodrigues B, Parsons N, Haridy J, Bloom S, Day C, Haar G, Nicoll A, Sawhney R. A nurse-led, telehealth-driven hepatitis C management initiative in regional Victoria: Cascade of care from referral to cure. J Telemed Telecare 2024; 30:497-504. [PMID: 34142898 DOI: 10.1177/1357633x211024108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elimination of hepatitis C virus stands as an unresolved World Health Organization target, and is associated with complications including cirrhosis and hepatocellular carcinoma. Hepatitis C virus management has been revolutionised following the widespread availability of direct-acting antiviral agents in Australia since 2016; however, large proportions of the population remain untreated. Telehealth-based service delivery is an accessible and effective alternative, and we aimed to assess qualitative and clinical outcomes in a clinical nurse consultant-led regional telehealth model. METHODS A prospective cohort analysis of all patients referred to a Victorian regional hospital's hepatitis C virus telehealth clinic between 1 April 2017 and 10 June 2020 was conducted. Data were collated from outpatient and electronic medical records. RESULTS Fifty-five out of 71 referred patients were booked, with 44 patients (80%) attending at least one appointment. A history of alcohol use disorder and psychiatric comorbidity was seen in 25 (54%) and 24 (52%) patients, respectively. Twenty-one out of 24 (88%) eligible patients had direct-acting antiviral agent treatment and 14 out of 21 (67%) successfully completed the treatment. An average of 46.5 km, 54.6 min and $AUD30.70 was saved per patient for each visit. Observed benefits included: increased medical engagement, adherence to and completion of HCV treatment and cirrhosis monitoring. Telehealth-driven hepatocellular carcinoma surveillance was successful in the cirrhotic subgroup. CONCLUSION Clinical nurse consultant-led hepatitis C virus management via telehealth allows access to marginalised regional populations. Clinical outcomes were comparable to other cohorts with additional cost-benefit, efficiency gains and carbon footprint reduction amongst a previously unreported regional Victorian hepatitis C virus population.
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Affiliation(s)
| | - Nola Parsons
- Department of Gastroenterology, Eastern Health, Australia
| | - James Haridy
- Department of Gastroenterology, Eastern Health, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Caroline Day
- Department of Gastroenterology, Eastern Health, Australia
| | - Geoffrey Haar
- Department of Gastroenterology, Eastern Health, Australia
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
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2
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Carson JM, Hajarizadeh B, Hanson J, O'Beirne J, Iser D, Read P, Balcomb A, Davies J, Doyle JS, Yee J, Martinello M, Marks P, Matthews GV, Dore GJ. Retreatment for hepatitis C virus direct acting antiviral therapy virological failure in primary and tertiary settings: the REACH-C cohort. J Viral Hepat 2022; 29:661-676. [PMID: 35583922 PMCID: PMC9542502 DOI: 10.1111/jvh.13705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 12/12/2022]
Abstract
Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real-world cohort. REACH-C is an Australian observational study (n=10843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019. Virological failure retreatment data were collected until October 2020. Of 408 people with virological failure (81% male; median age 53; 38% cirrhosis; 56% genotype 3), 213 (54%) were retreated once; 15 were retreated twice. A range of genotype specific and pangenotypic DAAs were used to retreat virological failure in primary (n=56) and tertiary (n=157) settings. Following sofosbuvir/velpatasvir/voxilaprevir availability in 2019, the proportion retreated in primary care increased from 21% to 40% and median time to retreatment initiation declined from 294 to 152 days. Per-protocol (PP) sustained virological response (SVR12) was similar for people retreated in primary and tertiary settings (80% vs 81%; p=1.000). In regression analysis, sofosbuvir/velpatasvir/voxilaprevir (vs. other regimens) significantly decreased likelihood of second virological failure (PP SVR12 88% vs. 77%; adjusted odds ratio [AOR] 0.29; 95%CI 0.11-0.81); cirrhosis increased likelihood (PP SVR12 69% vs. 91%; AOR 4.26; 95%CI 1.64-11.09). Indigenous Australians had lower likelihood of retreatment initiation (AOR 0.36; 95%CI 0.15-0.81). Treatment setting and prescriber type were not associated with retreatment initiation or outcome. Virological failure can be effectively retreated in primary care. Expanded access to simplified retreatment regimens through decentralised models may increase retreatment uptake and reduce HCV-related mortality.
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Affiliation(s)
| | | | - Josh Hanson
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Cairns and Hinterland Hospital and Health ServiceCairnsQueenslandAustralia
| | - James O'Beirne
- Sunshine Coast Hospital and Health ServiceSunshine CoastQueenslandAustralia
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
| | - David Iser
- Scope GastroenterologyMelbourneVictoriaAustralia
| | - Phillip Read
- Kirketon Road CentreSydneyNew South WalesAustralia
| | - Anne Balcomb
- Prince Street MedicalOrangeNew South WalesAustralia
| | - Jane Davies
- Menzies School of Health ResearchDarwinNorthern TerritoryAustralia
- Royal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - Joseph S. Doyle
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Infectious DiseasesThe Alfred and Monash UniversityMelbourneVictoriaAustralia
| | - Jasmine Yee
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | | | - Philippa Marks
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Gail V. Matthews
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- St Vincent's HospitalSydneyNew South WalesAustralia
| | - Gregory J. Dore
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- St Vincent's HospitalSydneyNew South WalesAustralia
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3
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Yee J, Carson JM, Hajarizadeh B, Hanson J, O'Beirne J, Iser D, Read P, Balcomb A, Doyle JS, Davies J, Martinello M, Marks P, Dore GJ, Matthews GV. High Effectiveness of Broad Access Direct-Acting Antiviral Therapy for Hepatitis C in an Australian Real-World Cohort: The REACH-C Study. Hepatol Commun 2022; 6:496-512. [PMID: 34729957 PMCID: PMC8870316 DOI: 10.1002/hep4.1826] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/29/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
Australia was one of the first countries with unrestricted access to government subsidized direct-acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow-up. Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice. Data were obtained on consecutive individuals who commenced DAAs from March 2016 to June 2019. Effectiveness was assessed by sustained virological response ≥12 weeks following treatment (SVR) using intention-to-treat (ITT) and per-protocol (PP) analyses. Within REACH-C, 10,843 individuals initiated DAAs (male 69%; ≥50 years 52%; cirrhosis 22%). SVR data were available in 85% (9,174 of 10,843). SVR was 81% (8,750 of 10,843) by ITT and 95% (8,750 of 9,174) by PP. High SVR (≥92%) was observed across all service types and participant characteristics. Male gender (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.43-0.72), cirrhosis (aOR 0.52, 95% CI 0.41-0.64), recent injecting drug use (IDU; aOR 0.64, 95% CI 0.46-0.91) and previous DAA treatment (aOR 0.50, 95% CI 0.28-0.90) decreased the likelihood of achieving SVR. Multiple factors modified the likelihood of loss to follow-up including IDU ± opioid agonist therapy (OAT; IDU only: aOR 1.75, 95% CI 1.44-2.11; IDU + OAT: aOR 1.39, 95% CI 1.11-1.74; OAT only, aOR 1.36; 95% CI 1.13-1.68) and age (aOR 0.97, 95% CI 0.97-0.98). Conclusion: Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy. Loss to follow-up presents a real-world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow-up.
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Affiliation(s)
- Jasmine Yee
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia
| | | | | | - Joshua Hanson
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,Cairns HospitalCairnsQLDAustralia
| | - James O'Beirne
- Sunshine Coast University HospitalSunshine CoastQLDAustralia
| | - David Iser
- Scope GastroenterologyMelbourneVICAustralia
| | | | | | - Joseph S Doyle
- Burnet InstituteMelbourneVICAustralia.,The Alfred and Monash UniversityDepartment of Infectious DiseasesMelbourneVICAustralia
| | - Jane Davies
- Royal Darwin HospitalDarwinAustralia.,Menzies School of Health ResearchDarwinAustralia
| | - Marianne Martinello
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,Blacktown Mount Druitt HospitalBlacktownNSWAustralia.,St Vincent's HospitalSydneyNSWAustralia
| | | | - Gregory J Dore
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,St Vincent's HospitalSydneyNSWAustralia
| | - Gail V Matthews
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,St Vincent's HospitalSydneyNSWAustralia
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Hayward KL, McKillen BJ, Horsfall LU, McIvor C, Liew K, Sexton J, Johnson AL, Irvine KM, Valery PC, McPhail SM, Britton LJ, Rosenberg W, Weate I, Williams S, Powell EE. Towards collaborative management of nonalcoholic fatty liver disease (TCM-NAFLD): a 'real-world' pathway for fibrosis risk assessment in primary care. Intern Med J 2021; 52:1749-1758. [PMID: 34139066 DOI: 10.1111/imj.15422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal strategy to support primary care practitioners (PCPs) to assess fibrosis severity in nonalcoholic fatty liver disease (NAFLD) and thereby make appropriate management decisions remains unclear. AIMS We aimed to examine the feasibility of using a 2-step pathway that combined simple scores (NAFLD Fibrosis Score and Fibrosis-4 Index) with transient elastography (FibroScan®) to streamline NAFLD referrals from a 'routine' primary care population to specialist hepatology management clinics (HMC). METHODS The 2-step "Towards Collaborative Management of NAFLD" (TCM-NAFLD) fibrosis risk assessment pathway was implemented at two outer metropolitan primary healthcare practices in Brisbane. Patients aged ≥18 years with a new or established PCP-diagnosis of NAFLD were eligible for assessment. The pathway triaged patients at "high risk" of clinically significant fibrosis to HMC for specialist review, and "low risk" patients to receive ongoing management and longitudinal follow-up in primary care. RESULTS A total of 162 patient assessments between Jun-2019 and Dec-2020 were included. Mean age was 58.7 ± 11.7 years, 30.9% were male, 54.3% had type 2 diabetes or impaired fasting glucose, and mean body mass index was 34.2 ± 6.9 kg/m2 . 122 patients were considered "low risk" for clinically significant fibrosis, two patients had incomplete assessments, and 38 (23.5%) were triaged to HMC. Among 31 completed HMC assessments to date, 45.2% were considered to have clinically significant (or more advanced) fibrosis, representing 9.2% of 153 completed assessments. CONCLUSION Implementation of the 2-step TCM-NAFLD pathway streamlined hepatology referrals for NAFLD and may facilitate a more cost-effective and targeted use of specialist hepatology resources. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kelly L Hayward
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Benjamin J McKillen
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Leigh U Horsfall
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Carolyn McIvor
- Department of Gastroenterology, Logan Hospital; Logan City QLD, Australia
| | - Katerina Liew
- Department of Gastroenterology, Logan Hospital; Logan City QLD, Australia
| | - Jo Sexton
- Department of Gastroenterology, Logan Hospital; Logan City QLD, Australia
| | - Amy L Johnson
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
| | - Katharine M Irvine
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Mater Research, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,QIMR Berghofer Medical Research Institute; Herston QLD, Australia
| | - Steven M McPhail
- Clinical Informatics Directorate, Metro South Health; Woolloongabba QLD, Australia.,Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology; Kelvin Grove QLD, Australia
| | - Laurence J Britton
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia.,Greenslopes Clinical School, Faculty of Medicine, The University of Queensland, Greenslopes QLD, Australia
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London; London, UK.,The Royal Free London, NHS Foundation Trust; London, UK
| | - Ingrid Weate
- Jimboomba Medical Centre; Jimboomba QLD, Australia
| | | | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia
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5
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Li W, Chang TS, Chang SZ, Chen CH, Chen MY. Challenges of transferring rural adults with chronic HCV infection for further HCV RNA confirmation and free DAAs treatment: a success story of the interdisciplinary collaboration approach. BMC Infect Dis 2020; 20:737. [PMID: 33028228 PMCID: PMC7542903 DOI: 10.1186/s12879-020-05435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background Chronic hepatitis C virus (HCV), which is a concern in many countries, is the leading cause of liver cancer around the world. Since Taiwan launched its national health insurance system in 1995, it has managed to extend health coverage to 99% of the Taiwanese population, providing free but limited antiviral treatment each year since 2017. However, many people in rural areas are unaware that they have chronic HCV; nor do they realize that new drugs with high cure rates could drastically reduce their health burden. The aim of this study is to explore the implementation facilitators of and barriers to inviting potentially infected patients in rural areas to be transferred for HCV ribonucleic acid (RNA) confirmation and new drug treatment. Methods A descriptive and prospective study design with an interdisciplinary collaboration approach was implemented. After five elements of referral were developed, telephone counseling was conducted between August 2018 and May 2019 in Yunlin, Taiwan. The elements of referral developed by the research team were: (1) forming and coordinating physicians’ schedules, (2) recruiting and training volunteers, (3) training the nursing staff, (4) raising funds or resources, and (5) connecting with village leaders. Thereafter, we collaborated with two district health centers, a private local hospital, and health clinics. Based on the medical records provided by these agencies, community adults that were HCV antibody (anti-HCV) positive were invited to join the program. Results Of the 1795 adults who were serum anti-HCV positive, 1149 (64%) accepted transfer to a qualified hospital; of these, 623 (54.2%) had an HCV infection. 552 (88.6%) of those infected started receiving direct-acting antivirals (DAAs) treatment. The top four barriers to accepting transfer were: (1) they perceived themselves to be healthy (n = 98, 32.3%); (2) mistrust of treatment/healthcare (n = 60, 20.2%); (3) limited transportation to the hospital (n = 52, 17.5%); and (4) work conflict (n = 30, 10.1%). Conclusion An interdisciplinary collaboration approach significantly contributed to the invitation of CHC patients, as well as their acceptance of HCV RNA confirmation and free DAAs treatment. Using anti-HCV data from previous medical records for case-finding and collaborating with a hospital and health clinics proved to be an efficient strategy.
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Affiliation(s)
- Wei Li
- Formosa Plastics Group Health Care, Yunlin, Taiwan
| | - Te-Sheng Chang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | | | - Ching-Hwa Chen
- Formosa Plastics Group, Advanced Engineer, Safety Health and Environment Center, Taipei, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan. .,Research Fellow, Department of Cardiology, Chang Gung Memorial Hospital, No. 2, Chiapu Rd. West Sec., Putz City, Chiayi County, 613, Taiwan. .,School of Nursing, Chang Gung University, Taoyuan, Taiwan.
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Haridy J, Iyngkaran G, Nicoll A, Muller K, Wilson M, Wigg A, Ramachandran J, Nelson R, Bloom S, Sasadeusz J, Watkinson S, Colman A, Altus R, Tilley E, Stewart J, Hebbard G, Liew D, Tse E. Outcomes of community-based hepatitis C treatment by general practitioners and nurses in Australia via remote specialist consultation. Intern Med J 2020; 51:1927-1934. [PMID: 32892478 DOI: 10.1111/imj.15037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/13/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND & AIMS A unique model of care was adopted in Australia following introduction of universal subsidised direct-acting antiviral (DAA) access in 2016 in order to encourage rapid scale-up of treatment. Community-based medical practitioners and integrated hepatitis nurses initiated DAA treatment with remote hepatitis specialist approval of the planned treatment without physical review. We aimed to evaluate outcomes of community-based treatment of hepatitis C (HCV) through this remote consultation process in the first 12 months of this model of care. METHODS A retrospective chart review of patients undergoing community-based HCV treatment from general practitioners and integrated hepatitis nurse consultants through the remote consultation model in three state jurisdictions in Australia from 1 March 2016 to 28 February 2017. RESULTS SVR12 was confirmed in 383/588 (65.1%) subjects intended for treatment with a median follow-up time of 12 months (IQR 9-14 months). The SVR12 test was not performed in 159/588 (27.0%) and 307/588 (52.2%) did not have liver biochemistry rechecked following treatment. Subjects who completed follow-up exhibited high SVR12 rates (383/392,97.7%). Nurse-led treatment was associated with higher confirmation of SVR12 (73.7% v 62.4%, p = 0.01) and liver biochemistry testing post treatment (57.5% v 45.0%, p = 0.01). CONCLUSIONS Community-based management of HCV through remote specialist consultation may be an effective model of care. Failure to check SVR12, recheck liver biochemistry and appropriate surveillance in patients with cirrhosis may emerge as significant issues requiring further support, education and refinement of the model to maximise effectiveness of future elimination efforts. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- James Haridy
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Australia.,Department of Gastroenterology, Eastern Health, Box Hill, Australia
| | - Guru Iyngkaran
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Australia.,Department of Gastroenterology, Royal Darwin Hospital, Darwin, Australia
| | - Amanda Nicoll
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Gastroenterology, Eastern Health, Box Hill, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Kate Muller
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, Australia
| | - Mark Wilson
- Department of Gastroenterology, Royal Hobart Hospital, Hobart, Australia
| | - Alan Wigg
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, Australia
| | - Jeyamani Ramachandran
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, Australia
| | - Renjy Nelson
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,Department of Infectious Diseases, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Box Hill, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Joseph Sasadeusz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Sally Watkinson
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Anton Colman
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Rosalie Altus
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, Australia
| | - Emma Tilley
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, Australia
| | - Jeffrey Stewart
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, Australia.,Department of Infectious Diseases, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Geoff Hebbard
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Edmund Tse
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
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Wu PS, Chang TS, Lu SN, Su HJ, Chang SZ, Hsu CW, Chen MY. An Investigation of the Side Effects, Patient Feedback, and Physiological Changes Associated with Direct-Acting Antiviral Therapy for Hepatitis C. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244981. [PMID: 31817863 PMCID: PMC6950306 DOI: 10.3390/ijerph16244981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 01/08/2023]
Abstract
Background: Hepatitis C virus (HCV) infection is one of the major causes of liver cirrhosis and hepatocellular carcinoma globally. The advent of direct-acting antivirals (DAAs) with high cure rates provides an opportunity to reduce the rising HCV disease burden. However, few studies have explored the side effects and physiological benefits of DAA therapy in rural areas. The aim of this study was to investigate the subjective reports of discomfort, patient feedback about the course of treatment, and physiological changes after DAA treatment in HCV patients. Methods: A descriptive, prospective, comparative cohort study was conducted from January to August 2019 in western coastal Yunlin County, Taiwan. Data regarding demographic characteristics, subjective discomfort levels, and physiological responses were collected through face to face interviews and from medical records by a cooperating hospital. Results: Six-hundred-and-twenty-three participants with an active HCV infection were identified; 555 (89.1%) had completed treatment, and sustained virologic response was achieved in 99.6% (n = 553). The mean age was 64.9 (standard deviation = 13.1) years, and 35% of patients experienced discomfort during DAA treatment, including fatigue, itching, and dizziness. After three months of treatment, physiological markers, including body weight (p < 0.001), waist circumference (p < 0.05), blood pressure (p < 0.001), alanine aminotransferase (p < 0.001), and aspartate aminotransferase (p < 0.001), had significantly improved. Almost all participants provided positive feedback about the treatment experience and reported manageable side effects. Conclusions: The findings showed that, in an endemic rural area, DAA treatment had a high cure rate and improved physiological markers with few discomforts. These results can be used to reduce the barriers HCV patients face in adopting new medications.
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Affiliation(s)
- Pin-Sheng Wu
- Formosa Plastics Group Health Care, Yunlin 638, Taiwan; (P.-S.W.); (S.-Z.C.)
| | - Te-Sheng Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (T.-S.C.); (S.-N.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Sheng-Nan Lu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (T.-S.C.); (S.-N.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiang-Jou Su
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 613, Taiwan;
| | - Shu-Zhi Chang
- Formosa Plastics Group Health Care, Yunlin 638, Taiwan; (P.-S.W.); (S.-Z.C.)
| | - Chia-Wen Hsu
- Formosa Plastics Group, Safety Health & Environment Center, Taipei 508, Taiwan;
| | - Mei-Yen Chen
- College of Nursing, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Nursing, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-(5)-3628800 (ext. 2301); Fax: +886-(5)-3628866
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8
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Mendizabal M, Ridruejo E, Ceballos S, Sixto M, Billordo A, Gadea C, Mengarelli S, Alonso C, Palazzo A, De María L, Bruno A, Perez D, Piñero F, Deltrozzo V, Mendoza C, Figueroa S, Manero E, Villa M, Barreyro F, Moreno V, Vilar J, Murga D, Fernandez M, O Flaherty M, Arora S, Silva M. The ECHO model proved to be a useful tool to increase clinicians' self-effectiveness for care of patients with Hepatitis C in Argentina. J Viral Hepat 2019; 26:1284-1292. [PMID: 31273860 DOI: 10.1111/jvh.13172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 01/22/2023]
Abstract
The ECHO model was developed to expand access to medical care for populations with HCV infection in underserved areas. We aimed to compare HCV treatment outcomes in community-based clinics with the Austral University Hospital (AUH) and to assess improvement in physician knowledge and skills. In October 2015, we established an HCV ECHO clinic at the AUH in Buenos Aires. To evaluate the impact of this programme, we conducted a prospective cohort study comparing treatment for HCV infection at the AUH with healthcare providers from different Argentinean provinces. A survey evaluating skills and competence in HCV care was administered, and results were compared. The primary endpoint was sustained virologic response (SVR) and under direct-acting antivirals. Since the implementation of ECHO clinics, a total of 25 physicians participated in at least one session (median 10.0; IQR 3.0-18.0). SVR rates (n = 437 patients) were 94.2% (95% CI 90.4-96.8) in patients treated at AUH clinic (n = 227/242) and 96.4% (95% CI 92.7-98.5) in those treated at ECHO sites (n = 188/195), with a nonsignificant difference between sites, 2.2% SVR difference (95% CI -0.24-0.06; P = 0.4). We also found a significant improvement in all the evaluated skills and abilities. Replicating the ECHO model helped to improve participants' skills in the management of HCV achieving similar SVR rates. ECHO model was demonstrated to be an effective intervention able to multiply and expand HCV treatment, a critical barrier to access to care that needs to be solved if we are committed with WHO goals to eliminate HCV by 2030.
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Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Ezequiel Ridruejo
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.,Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | | | | | | | - Claudia Gadea
- Sanatorio Pasquini, San Miguel de Tucumán, Argentina
| | | | - Cristina Alonso
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Ana Palazzo
- Hospital Padilla, San Miguel de Tucumán, Argentina
| | | | | | | | - Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | | | | | | | - Estela Manero
- Hospital Pablo Soria, San Salvador de Jujuy, Argentina
| | | | | | | | - José Vilar
- Asociación Argentina para el Estudio de las Enfermedades del Hígado, Corrientes, Argentina
| | | | | | - Martin O Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sanjeev Arora
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
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Mendizabal M, Alonso C, Silva MO. Overcoming barriers to hepatitis C elimination. Frontline Gastroenterol 2019; 10:207-209. [PMID: 31288259 PMCID: PMC6583574 DOI: 10.1136/flgastro-2018-101114] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/03/2019] [Accepted: 01/15/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Cristina Alonso
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Marcelo O Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
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