22 research outputs found
Impact of âSambhavâ Program (Financial Assistance and Counselor Services) on Hepatitis C Pegylated Interferon Alpha Treatment Initiation in India
Abstract
Background: Financial constraints, social taboos and beliefs in alternative medicine are common reasons for delaying or
not considering treatment for hepatitis C in India. The present study was planned to analyze the impact of non-banking
interest free loan facility in patients affected with hepatitis C virus (HCV) in North India.
Methods: This one year observational, retrospective study was conducted in Department of Gastroenterology (January
2012-December 2013), Dayanand Medical College and Hospital Ludhiana, to evaluate the impact of program titled
âSambhavâ (which provided non-banking financial assistance and counselor services) on treatment initiation and
therapeutic compliance in HCV patients. Data of fully evaluated patients with chronic hepatitis, and/or cirrhosis due to
HCV infection who were treated with Peginterferon alfa and ribavirin (RBV) combination during this duration (2012-
2013) was collected from patient medical records and analyzed. In the year 2012, eligible patients who were offered
antiviral treatment paid for treatment themselves, while in 2013, âSambhavâ program was launched and this provided
interest free financing by non-banking financial company (NBFC) for the treatment of HCV in addition to free counselor
services for disease management. The treatment initiation and compliance rates were compared between the patients (n
= 585) enrolled in 2013 who were offered âSambhavâ assistance and those enrolled in 2012 (n = 628) when âSambhavâ
was not available.
Results: Introduction of Sambhav program improved the rates of treatment initiation (59% in 2013 vs. 51% in 2012,
P=.004). Of the 585 eligible patients offered âSambhavâ assistance in 2013, 233 patients (39.8%) applied but 106/233
(45.4%) received assistance. Antiviral therapy was started in 93/106 (87.7%) of these patients, while only 52 (42.5%) of
127 patients whose applications were rejected underwent treatment. Compliance to antiviral therapy also improved with
the introduction of âSambhavâ program (87.7% vs. 74.1%, P=.001).
Conclusion: âSambhavâ program had significant impact on the initiation of antiviral therapy by overcoming the financial
hurdles. The free counselor services helped to mitigate social taboos and imparted adequate awareness about the disease
to the patients. Initiatives like âSambhavâ can be utilized for improving healthcare services in developing countries,
especially for chronic diseases
A simple phenotypic classification for celiac disease
Background/AimsCeliac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease.MethodsVarious variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields.ResultsAfter empirical verification, age at diagnosis was considered appropriate in between A1 (<18) and A2 (â„18). The disease presentation has been classified into 3 typesâP1 (classical), P2 (non-classical) and P3 (asymptomatic). Complications were considered as absent (C0) or present (C1). A single phenotypic classification based on these 3 characteristics, namely age at the diagnosis, clinical presentation, and intestinal complications (APC classification) was derived.ConclusionsAPC classification (age at diagnosis, presentation, complications) is a simple disease explanatory classification for patients with celiac disease aimed at providing a composite diagnosis