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Boeke CE, Adesigbin C, Adisa O, Agwuocha C, Akanmu MM, Anartati A, Aung KS, Azania A, Bello Nabe R, Budiman A, Chan Y, Chawla U, Fatchanuraliyah, Fernandes O, Grover GS, Naing TS, Ngo D, Ramers CB, Regan S, Sindhwani S, Tandy G, Tint K, Nguyen KV, Witschi M, McClure C. Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries. BMJ Open 2022; 12:e062745. [PMID: 36576192 PMCID: PMC9723848 DOI: 10.1136/bmjopen-2022-062745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Given limited data on factors associated with hepatitis C virus (HCV) treatment discontinuation and failure in low- and middle-income countries, we aimed to describe patient populations treated for HCV in five countries and identify patient groups that may need additional support. DESIGN Retrospective cohort analysis using routinely collected data. SETTING Public sector HCV treatment programmes in India (Punjab), Indonesia, Myanmar, Nigeria (Nasarawa) and Vietnam. PARTICIPANTS 104 957 patients who initiated treatment in 2016-2022 (89% from Punjab). PRIMARY OUTCOMES Treatment completion and cure. RESULTS Patient characteristics and factors associated with outcomes varied across countries and facilities. Across all patients, median age was 40 years (IQR: 29-52), 30.6% were female, 7.0% reported a history of injecting drugs, 18.2% were cirrhotic and 4.9% were coinfected with HIV. 79.8% were prescribed sofosbuvir+daclastasvir. Of patients with adequate follow-up, 90.6% (89,551) completed treatment. 77.5% (69,426) of those who completed treatment also completed sustained virological testing at 12 weeks (SVR12), and of those, 92.6% (64 305) were cured. In multivariable-adjusted models, in most countries, significantly lower treatment completion was observed among patients on 24-week regimens (vs 12-week regimens) and those initiated in later years of the programme. In several countries, males, younger patients <20 years and certain groups of cirrhotic patients were less likely to complete treatment or be cured. In Punjab, treatment completion was also lower in those with a family history of HCV and people who inject drugs (PWID); in other countries, outcomes were comparable for PWID. CONCLUSION High proportions of patients completed treatment and were cured across patient groups and countries. SVR12 follow-up could be strengthened. Males, younger people and those with decompensated cirrhosis on longer regimens may require additional support to complete treatment and achieve cure. Adequate programme financing, minimal user fees and implementation of evidence-based policies will be critical to close gaps.
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Affiliation(s)
| | - Clement Adesigbin
- National AIDS/STIs Control Programme, Federal Ministry of Health, Abuja, FCT, Nigeria
| | | | | | | | | | - Khin Sanda Aung
- National Hepatitis Control Program, Department of Public Health, Ministry of Health, Naypyidaw, Myanmar
| | - Amy Azania
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | - Arief Budiman
- Clinton Health Access Initiative, Jakarta, Indonesia
| | - Yuhui Chan
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | - Fatchanuraliyah
- Directorate of Communicable Disease Prevention and Control, Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Oriel Fernandes
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Gagandeep Singh Grover
- State Viral Hepatitis Management Unit, Department of Health and Family Welfare, Government of Punjab, Chandigarh, Punjab, India
| | | | - Dang Ngo
- Clinton Health Access Initiative, Hanoi, Viet Nam
| | | | - Sean Regan
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | - Gertrudis Tandy
- Directorate of Communicable Disease Prevention and Control, Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Khin Tint
- Clinton Health Access Initiative, Yangon, Myanmar
| | | | | | - Craig McClure
- Clinton Health Access Initiative, Boston, Massachusetts, USA
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Lau AA, Strebe JK, Sura TV, Hansen LA, Jain MK. Predictors of linkage to hepatitis C virus care among people living with HIV with hepatitis C infection and the impact of loss to HIV follow‐up. Health Sci Rep 2022; 5:e645. [PMID: 35620551 PMCID: PMC9125878 DOI: 10.1002/hsr2.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/08/2022] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Half of the people living with HIV (PLWH) with hepatitis C virus (HCV) remain untreated for HCV. We examined predictors of HCV linkage to care among PLWH and the impact of HIV lost to care. Design and methods We conducted a retrospective review of PLWH/HCV from our HIV clinics between 2014 and 2017, and examined predictors of HCV linkage to care. We used the Kaplan–Meier method to estimate the probability of HIV retention and HCV linkage over time. Results Of 615 PLWH/HCV, 34% linked to HCV care and 21% were cured. Higher odds of linkage to HCV care were among blacks (adjusted odds ratio [aOR]: 2.95, 95% confidence interval [CI]: 1.59, 5.47), prior injection drug users (IDUs; aOR: 2.89, 95% CI: 1.39, 6.01), Medicare (aOR: 3.09, 95% CI: 1.56, 6.11), and cirrhotics (aOR: 2.80, 95% CI: 1.52, 5.14). Reduced odds for linkage were in active IDU (aOR: 0.16, 95% CI: 0.05, 0.45) and those seen by an advanced practice provider (aOR: 0.53, 95% CI: 0.30, 0.92). The main reason for failure to link to HCV care was lost to HIV care. At 3 years, the overall probability of being retained in HIV care was 53%; among those who had an HCV evaluation visit, it was 75% vs. 41% with no HCV evaluation visit. Accounting for loss to follow‐up, PLWH/HCV had a 65% probability of having an HCV evaluation at 3 years. HCV is a curable infection in those with or without HIV. Yet, high proportions of people living with HIV with HCV remain untreated for HCV, leading to complications of liver disease and death. Our study found that only one‐third of HIV/HCV patients were linked to HCV care. The main reason for not linking to HCV care was that increasing numbers of patients drop out of HIV care over time. Our study suggests that early focus on HCV treatment would increase the number of patients cured, but it is unclear whether this would impact retention in HIV care.
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Affiliation(s)
- Abby A. Lau
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine UT Southwestern Medical Center Dallas Texas USA
- Parkland Health and Hospital System Dallas Texas USA
| | | | - Teena V. Sura
- Population and Data Science, UT Southwestern Medical Center Dallas Texas USA
| | - Laura A. Hansen
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine UT Southwestern Medical Center Dallas Texas USA
| | - Mamta K. Jain
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine UT Southwestern Medical Center Dallas Texas USA
- Parkland Health and Hospital System Dallas Texas USA
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Ranes de Menezes Filho H, Maia LG, Machado SM, Ramos da Silva I, de Almeida-Neto C, Sabino EC, Witkin SS, Mendes-Corrêa MC. Knowledge of Hepatitis C virus vertical transmission and subsequent pregnancy outcome in virus-positive female blood donors. Braz J Infect Dis 2022; 26:102334. [PMID: 35180448 PMCID: PMC9387468 DOI: 10.1016/j.bjid.2022.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/18/2021] [Accepted: 01/01/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) can be vertically transmitted from mother to fetus. We evaluated knowledge about HCV vertical transmission in female blood donors who became pregnant following detection of HCV in their donated blood. Methods This was a retrospective descriptive study of females seen at a single blood bank in Sao Paulo, Brazil who were diagnosed with HCV infection in their donated blood. HCV-infected donors who subsequently became pregnant were invited to participate through letters or phone calls. Individuals who agreed to participate were interviewed by questionnaire to evaluate their knowledge on HCV vertical transmission. Results Among 282 HCV-positive female blood donors, 69 reported becoming pregnant after their HCV diagnosis in donated blood. While 24 of these women were successful treated for their infection prior to becoming pregnant, 45 (65.2%) were at risk for vertical HCV transmission either because they had never been treated for HCV, were pregnant before treatment or became pregnant after unsuccessful treatment. Of the 59 women who responded to the question of whether they were informed about the risk of HCV vertical transmission, 58 (98.3%) reported never receiving this information either after obtaining their blood donation results or during their pregnancy. Conclusion The lack of knowledge of HCV-infected women on the possibility for mother-to-child transmission of this virus highlights the critical need to improve communication about pregnancy-related risks between health professionals and HCV-infected women of childbearing age.
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Elbahrawy A, Ibrahim MK, Eliwa A, Alboraie M, Madian A, Aly HH. Current situation of viral hepatitis in Egypt. Microbiol Immunol 2021; 65:352-372. [PMID: 33990999 DOI: 10.1111/1348-0421.12916] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.
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Affiliation(s)
- Ashraf Elbahrawy
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Marwa K Ibrahim
- Department of Microbial Biotechnology, Division of Genetic Engineering and Biotechnology Research, National Research Centre, Giza, Egypt.,Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ahmed Eliwa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Madian
- Department of Internal Medicine, Al-Azhar University, Assiut, Egypt
| | - Hussein Hassan Aly
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions: A Matched Analysis. Spine (Phila Pa 1976) 2021; 46:E559-E565. [PMID: 33273439 DOI: 10.1097/brs.0000000000003829] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The aim of this study was to analyze association between social determinants of health (SDH) disparity on postoperative complication rates, and 30-day and 90-day all-cause readmission in patients undergoing single-level lumbar fusions. SUMMARY OF BACKGROUND DATA Decreasing postoperative complication rates is of great interest to surgeons and healthcare systems. Postoperative complications are associated with poor convalescence, inferior patient reported outcomes measures, and increased health care resource utilization. Better understanding of the association between Social Determinants of Health (SDH) on postoperative outcomes maybe helpful to decrease postoperative complication rates. METHODS MARINER 2020, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2018. The primary outcomes were the rates of any postoperative complication, symptomatic pseudarthrosis, need for revision surgery, or 30-day and 90-day all-cause readmission. RESULTS The exact matched population analyzed in this study contained 16,560 patients (8280 [50.0%] patients undergoing single-level lumbar fusion with an SDH disparity; 8280 [50.0%] patients undergoing single-level lumbar fusion without a disparity). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis (1.0% vs. 0.6%, P < 0.05) or any postoperative complication (16.3% vs. 10.4%, P < 0.05) in the matched analysis was higher in the disparity group. The presence of a disparity was associated with 70% increased odds of developing any complication (OR 1.7, 95% CI 1.53-1.84) or symptomatic pseudarthrosis (OR 1.7, 95% CI 1.17-2.37). Unadjusted and adjusted sensitivity analyses yielded similar results as the primary analysis. CONCLUSION Social Determinants of Health affect outcomes in spine surgery patients and are associated with an increased risk of developing postoperative complications following lumbar spine fusion.Level of Evidence: 3.
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Carvalho-Louro DM, Soares EB, Trevizoli JE, Marra TMG, da Cunha ALR, Rodrigues MP, Carvalho-Furtado ACL, Dos Santos BTA, de Assis da Rocha Neves F. Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil. BMC Infect Dis 2020; 20:114. [PMID: 32041537 PMCID: PMC7011476 DOI: 10.1186/s12879-020-4809-2] [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: 10/11/2019] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals. Methods This cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography. Results The prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication. Conclusions The prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis. Trial registration Research Ethics Committee of the Faculty of Health Sciences of the University of Brasília - UNB (CAAE number 77818317.2.0000.0030) and by the Ethics Committee of the Health Science Teaching and Research Foundation - FEPECS/SES/DF (CAAE number 77818317.2.3001.5553).
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Affiliation(s)
| | - Eric Bassetti Soares
- Gilead Sciences Farmacêutica do Brasil Ltd. and Liver Center at UFMG, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 04711-130, Brazil
| | - Jose Eduardo Trevizoli
- Gastroenterology Unit, Instituto Hospital de Base, Brasilia, Federal District, 70322-000, Brazil
| | - Thayna Moreira Gomes Marra
- Postgraduate Program in Health Sciences and Technologies, University of Brasilia, Brasilia, Federal District, 70919-970, Brazil
| | | | - Marcelo Palmeira Rodrigues
- Pneumology Unit, Faculty of Medicine, University of Brasilia, Brasilia, Federal District, 70673-432, Brazil
| | | | - Beatriz Taynara Araujo Dos Santos
- Subsecretaria de Atencao Integral a Saude, Secretaria do Estado de Saude do Distrito Federal, Brasilia, Federal District, 70770-200, Brazil
| | - Francisco de Assis da Rocha Neves
- Molecular Pharmacology Laboratory, Faculty of Health Sciences, University of Brasilia, Brasilia, Federal District, 70919-970, Brazil
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Calner P, Sperring H, Ruiz-Mercado G, Miller NS, Andry C, Battisti L, Scrudder K, Shea F, Chan A, Schechter-Perkins EM. HCV screening, linkage to care, and treatment patterns at different sites across one academic medical center. PLoS One 2019; 14:e0218388. [PMID: 31291275 PMCID: PMC6619669 DOI: 10.1371/journal.pone.0218388] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/01/2019] [Indexed: 12/20/2022] Open
Abstract
Background It is unclear whether sites that screen large numbers of patients for Hepatitis C Virus but achieve limited follow-up are more or less effective at having patients succeed through linkage and treatment than lower volume sites that have higher linkage percentages. The objective was to compare the rates of HCV identification, linkage to care, and treatment success between different study sites including the Emergency Department, 3 outpatient clinics with unique patients, and the inpatient setting at one medical center Methods This is a descriptive analysis of 2 years of data from a protocol that integrated HCV screening and treatment into clinical services throughout multiple departments in one medical center. The program used a best practice advisory to prompt testing at all sites, with different triggers for it to fire at each site, and one central navigation program that attempted to link all patients diagnosed with hepatitis C virus to outpatient care. Outcomes included volume of tests performed in each site, Antibody and RNA rates at each site, demographic data, navigation and linkage outcomes, and post-linkage treatment completion. Results 28,435 patients were screened across 5 clinical locations. RNA+ rates and absolute numbers linked to MD (linkage rates among all RNA+) were: ED 7.2% RNA+, 224 (22.6%) linked; Inpatient 14.8% RNA+, 27 (17.6%) linked, General Internal Medicine 3.9% RNA+, 269 (65.8%) linked, Infectious Diseases 4.0% RNA+, 34(70.8%) linked, Family Medicine 2.0% RNA+, 28 (75.7%) linked. Demographics, linkage barriers, and treatment initiation rates were different at all sites. Conclusion Among sites there were differences in the sociodemographic characteristics of patients diagnosed with HCV, as well as differences in the success linking patients to outpatient care. At this medical center, the ED screened the most patients, the inpatient area had the highest RNA positivity rate, the FM clinic had the highest linkage rate, GIM linked the most patients by absolute number, and GIM also had the highest number of patients start treatment.
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Affiliation(s)
- Paul Calner
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Heather Sperring
- Boston University Master’s Program in Public Health, Section of Infectious Disease, Department of General Internal Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Glorimar Ruiz-Mercado
- Center for Infectious Diseases and Public Health Programs Section of Infectious Diseases, Department of General Internal Medicine Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Nancy S. Miller
- Clinical Microbiology & Molecular Diagnostics Laboratory Medicine, Boston University Medical Center, Department of Pathology & Laboratory Medicine, Boston, Massachusetts United States of America
| | - Chris Andry
- Clinical Microbiology & Molecular Diagnostics Laboratory Medicine, Boston University Medical Center, Department of Pathology & Laboratory Medicine, Boston, Massachusetts United States of America
| | - Leandra Battisti
- Department of Pharmacy Operations & Project Management, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Katy Scrudder
- Center for Infectious Diseases and Public Health Programs Section of Infectious Diseases, Department of General Internal Medicine Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Fiona Shea
- Center for Infectious Diseases and Public Health Programs Section of Infectious Diseases, Department of General Internal Medicine Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Angelica Chan
- Center for Infectious Diseases and Public Health Programs Section of Infectious Diseases, Department of General Internal Medicine Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Elissa M. Schechter-Perkins
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
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Zuckerman A, Carver A, Chastain CA. Building a Hepatitis C Clinical Program: Strategies to Optimize Outcomes. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018; 10:431-446. [PMID: 30524209 PMCID: PMC6244618 DOI: 10.1007/s40506-018-0177-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW An increasing number of specialists and non-specialists are developing clinical programs to treat and cure hepatitis C virus (HCV). The goal of this paper is to evaluate and describe optimal strategies to improve outcomes related to HCV care delivery. RECENT FINDINGS Screening and diagnosis of HCV should be guided by established recommendations. Given the recognized disparity in HCV diagnosis and linkage to care, a multi-modal approach involving care coordination and technology resources should be used to improve patient engagement. Access to HCV treatment may be optimized through systematic documentation, prior authorization, and appeal processes. Treatment monitoring should emphasize medication adherence, side effect and drug interaction management, as well as elimination of practical barriers. Finally, post-treatment engagement to promote liver health and reduce the risk of complications or reinfection maximizes the benefit of HCV treatment. SUMMARY The landscape of HCV treatment has evolved from a specialist-driven model with few patients qualifying for treatment to an opportunity for non-specialists and other providers to provide curative therapies in most patients. Innovative practice models that employ a multidisciplinary approach will likely improve screening, diagnosis, engagement, and treatment outcomes.
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Affiliation(s)
- Autumn Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Alicia Carver
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Cody A. Chastain
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2200 MCN, 1161 21st Avenue, Nashville, TN 37232-2605 USA
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Zuckerman A, Douglas A, Nwosu S, Choi L, Chastain C. Increasing success and evolving barriers in the hepatitis C cascade of care during the direct acting antiviral era. PLoS One 2018; 13:e0199174. [PMID: 29912944 PMCID: PMC6005558 DOI: 10.1371/journal.pone.0199174] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/02/2018] [Indexed: 12/17/2022] Open
Abstract
Barriers remain in the hepatitis C virus (HCV) cascade of care (CoC), limiting the overall impact of direct acting antivirals. This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real world population. We performed a single-center, ambispective cohort study of patients receiving care in an outpatient infectious diseases clinic between October 2015 and September 2016. Patients were followed from treatment referral through sustained virologic response. Univariate and multivariate analyses were performed to identify factors related to completion of each step of the CoC. Of 187 patients meeting inclusion criteria, 120 (64%) completed an evaluation for HCV treatment, 119 (64%) were prescribed treatment, 114 (61%) were approved for treatment, 113 (60%) initiated treatment, 107 (57%) completed treatment, and 100 (53%) achieved a sustained virologic response. In univariate and multivariate analyses, patients with Medicaid insurance were less likely to complete an evaluation and were less likely to be approved for treatment. Treatment completion and SVR rates are much improved from historical CoC reports. However, linkage to care following referral continues to be a formidable challenge for the HCV CoC in the DAA era. Ongoing efforts should focus on linkage to care to capitalize on DAA treatment advances and improving access for patients with Medicaid insurance.
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Affiliation(s)
- Autumn Zuckerman
- Vanderbilt Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Andrew Douglas
- Belmont University, College of Pharmacy, Nashville, Tennessee, United States of America
| | - Sam Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Cody Chastain
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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