4 research outputs found
Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention
BackgroundAround 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model.MethodsThe Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods.InterventionBBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI.ResultsTwo years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period.ConclusionsImplementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics
Nuevos horizontes en la epidemiolog铆a, cl铆nica, tratamiento y cribado de la infecci贸n por el virus de la hepatitis C en la era de los antivirales de acci贸n directa
La infecci贸 pel virus de l鈥檋epatitis C ha canviat radicalment despr茅s de l鈥檃parici贸 dels nous antivirals d鈥檃cci贸 directa, fet que ha perm猫s plantejar-se fins i tot l鈥檈radicaci贸 de la infecci贸.
L鈥檕bjectiu d鈥檃questa tesi pret茅n establir nous horitzons cap a la identificaci贸, el cribratge i el maneig de l鈥檋epatitis C des de tres angles diferents com s贸n l鈥檈pidemiologia, el tractament i el diagn貌stic.
El primer treball d鈥檃questa tesi doctoral t茅 la intenci贸 de descriure l鈥檈tiologia de les hepatitis agudes virals en una cohort d鈥檃dults atesos al servei d鈥檜rg猫ncies de l鈥橦ospital Vall d鈥橦ebron durant 4 anys. Dels 100 casos d鈥檋epatitis viral, l鈥檋epatitis B continua sent l鈥檈tiologia m茅s freq眉ent amb un 28% dels casos, predominant en pacients emigrants de zones sense programes de vacunaci贸 universal. La segona etiologia va ser el virus de l鈥檋epatitis E amb un 18% dels casos, probablement associat a la millora de les t猫cniques diagn貌stiques actuals. Finalment, el virus de l鈥檋epatitis C ocupa la tercera causa i 茅s l鈥檈tiologia amb m茅s impacte sanitari condicionant l鈥檌ngr茅s de fins a un 76% dels casos. El factor de risc m茅s freq眉ent associat a la infecci贸 per virus hepatitis C van ser les conductes sexuals de risc. Cronificaren un 41% dels pacients, aconseguint tots ells la curaci贸 amb antivirals d鈥檃cci贸 directa.
Tot i les altes taxes de curaci贸 amb antivirals d鈥檃cci贸 directa contra la infecci贸 pel VHC, hi ha un 5% de pacients que hi fracassen. El segon treball va avaluar en una cohort multic猫ntrica espanyola, l鈥檈fic脿cia i la seguretat de sofosbuvir/velpatasvir/voxilaprevir en pacients amb hepatitis C cr貌nica. S鈥檋i van incloure 137 pacients que havien fracassat pr猫viament a un tractament amb antivirals d鈥檃cci贸 directa. Es va reportar una resposta virol貌gica sostinguda del 95% veient-se que el grau de fibrosi hep脿tica o la pres猫ncia de substitucions associades a resist猫ncies no van impactar sobre la resposta. Els pacients no responedors van ser majorit脿riament genotip 3 amb fibrosi hep脿tica avan莽ada i que havien rebut la combinaci贸 de sofosbuvir/daclatasvir. El tractament va ser segur, no es van reportar efectes secundaris rellevants.
En l铆nia amb les recomanacions de l鈥橭MS sobre l鈥檈liminaci贸 del virus de l鈥檋epatitis C l鈥檃ny 2030, es va plantejar el tercer treball que compon aquesta tesi doctoral. Es va dissenyar un estudi poblacional mitjan莽ant una estrat猫gia de salut de cribratge de la infecci贸 pel virus hepatitis C a les urg猫ncies de l鈥橦ospital Universitari Vall d鈥橦ebron. Es van garbellar 17.560 adults a urg猫ncies durant dos anys. La prevalen莽a d鈥檃nticossos anti-VHC va ser de 3,8% i d鈥檌nfecci贸 activa del 0,7% (ARN del VHC detectable), prevalences tres vegades superiors que a la poblaci贸 general. El 54% dels pacients amb hepatitis C activa es van vincular a consultes d鈥檋epatologia. Aix铆 mateix, es va realitzar un estudi cost-efectivitat de l鈥檈strat猫gia de cribratge del virus hepatitis C concloent que el cribratge a urg猫ncies 茅s cost-efectiu de forma similar a altres estrat猫gies de cribratge ben establertes.
Aix铆, doncs, aquesta tesi doctoral conclou que el virus hepatitis C continua sent rellevant com a agent etiol貌gic d鈥檋epatitis aguda mostrant un canvi de paradigma en els pacients i factors de risc associats a aquesta infecci贸. Tot i l鈥檃lta efic脿cia dels antivirals d鈥檃cci贸 directa contra el virus de l鈥檋epatitis C segueixen existint un redu茂t nombre d鈥檈rrors terap猫utics que es poden rescatar de manera segura i efectiva mitjan莽ant la combinaci贸 de sofosbuvir/velpatasvir/voxilaprevir. L鈥檈radicaci贸 de l鈥檋epatitis C ha d鈥檈ncaminar-se a incrementar el diagn貌stic mitjan莽ant programes de cribratge. Els serveis d鈥檜rg猫ncies poden ser un escenari on estrat猫gies de cribratge i vinculaci贸 poden ser altament cost-efectives.La infecci贸n por el virus de la hepatitis C ha cambiado radicalmente tras la aparici贸n de los nuevos antivirales de acci贸n directa, hecho que ha permitido hasta plantearse la erradicaci贸n de la infecci贸n.
El objetivo de esta tesis pretende establecer nuevos horizontes hacia la identificaci贸n, cribado y manejo de la hepatitis C desde tres 谩ngulos diferentes como son la epidemiolog铆a, el tratamiento y el diagn贸stico.
El primer trabajo de esta tesis doctoral tiene la intenci贸n de describir la etiolog铆a de las hepatitis agudas virales en una cohorte de adultos atendidos en el servicio de urgencias del Hospital Vall d鈥橦ebron durante 4 a帽os. De los 100 casos de hepatitis viral, la hepatitis B sigue siendo la etiolog铆a m谩s frecuente con un 28% de los casos, predominando en pacientes emigrantes de zonas sin programas de vacunaci贸n universal. La segunda etiolog铆a fue el virus de la hepatitis E con un 18% de los casos, probablemente asociado a la mejor铆a de las t茅cnicas diagn贸sticas actuales. Finalmente, el virus de la hepatitis C ocupa la tercera causa siendo la etiolog铆a con m谩s impacto sanitario, ingresando hasta un 76% de los casos. El factor de riesgo m谩s frecuente asociado a la infecci贸n por virus hepatitis C fueron las conductas sexuales de riesgo. Cronificaron un 41% de los pacientes, alcanzando todos ellos la curaci贸n con antivirales de acci贸n directa.
Pese a las altas tasas de curaci贸n con antivirales de acci贸n directa contra la infecci贸n por el VHC, existe un 5% de pacientes que fracasan a estos. El segundo trabajo evalu贸 en una cohorte multic茅ntrica espa帽ola, la eficacia y seguridad de sofosbuvir/velpatasvir/voxilaprevir en pacientes con hepatitis C cr贸nica. Se incluyeron 137 pacientes que hab铆an fracasado previamente a un tratamiento con antivirales de acci贸n directa. Se report贸 una respuesta virol贸gica sostenida del 95% vi茅ndose que el grado de fibrosis hep谩tica o la presencia de sustituciones asociadas a resistencias no impactaron sobre la respuesta. Los pacientes no respondedores fueron mayoritariamente genotipo 3 con fibrosis hep谩tica avanzada y que hab铆an recibido la combinaci贸n de sofosbuvir/daclatasvir. El tratamiento result贸 ser seguro, no se reportaron efectos secundarios relevantes.
En l铆nea con las recomendaciones de la OMS sobre la eliminaci贸n del virus de la hepatitis C en el a帽o 2030 se plante贸 el tercer trabajo que compone esta tesis doctoral. Se dise帽贸 un estudio poblacional a trav茅s de una estrategia de salud de cribado de la infecci贸n por el VHC en las urgencias del Hospital Universitari Vall d鈥橦ebron. Se cribaron 17.560 adultos en urgencias durante dos a帽os. La prevalencia de anticuerpos anti-VHC fue de 3,8% y de infecci贸n activa del 0,7% (ARN del VHC detectable), prevalencias tres veces superiores que en la poblaci贸n general. Se vincularon a consultas de hepatolog铆a el 54% de los pacientes con hepatitis C activa. Asimismo, se realiz贸 un estudio coste-efectividad de la estrategia de cribado del virus hepatitis C concluyendo que el cribado en urgencias es coste-efectivo de forma similar a otras estrategias de cribado bien establecidas.
As铆 pues, esta tesis doctoral concluye que el virus hepatitis C sigue siendo relevante como agente etiol贸gico de hepatitis aguda mostrando un cambio de paradigma en los pacientes y factores de riesgo asociados a dicha infecci贸n. Pese a la alta eficacia de los antivirales de acci贸n directa contra el virus de la hepatitis C siguen existiendo un reducido n煤mero de fallos terap茅uticos que pueden rescatarse de forma segura y efectiva mediante la combinaci贸n de sofosbuvir/velpatasvir/voxilaprevir. La erradicaci贸n de la hepatitis C debe encaminarse a incrementar el diagn贸stico a trav茅s de programas de cribado. Los servicios de urgencias pueden ser un escenario en donde estrategias de cribado y vinculaci贸n pueden ser altamente coste-efectivas.Hepatitis C virus infection has undergone a radical change in recent years. The emergence of new direct-acting antivirals has made possible to consider strategies for eradicating the infection.
The aim of this thesis is to establish new horizons towards the identification, screening, and management of hepatitis C from three different angles such as epidemiology, treatment, and screening.
The first work of this doctoral thesis aims to describe the aetiology of acute viral hepatitis in a cohort of adults treated in the emergency department of the Hospital Vall d鈥橦ebron over a period of 4 years. Of the 100 cases recorded, hepatitis B remains the most frequent aetiology with 28% of cases, predominantly in migrant patients from areas without universal vaccination programmes. Hepatitis E virus was described as the second most frequent aetiology with 18% of cases, probably associated with the improvement of current diagnostic techniques. Finally, hepatitis C virus was the third cause, being the aetiology with the highest health impact, accounting for 76% of cases. The most frequent risk factor associated with HCV infection was risky sexual behaviour. Chronic disease progression was observed in 41% of patients, all of whom were cured with direct-acting antivirals.
Despite the high cure rates with direct-acting antivirals against hepatitis C virus infection, there are 5% of patients who fail these antivirals. The second study in this dissertation evaluated the efficacy and safety of the combination sofosbuvir/velpatasvir/voxilaprevir in patients with chronic hepatitis C in a Spanish multicentre cohort. A total of 137 patients who had previously failed treatment with direct-acting antivirals were included. A 95% sustained virologic response was reported, showing that the degree of liver fibrosis or the presence of resistance-associated substitutions did not impact response. Non-responders were mostly genotype 3 patients with advanced liver fibrosis or cirrhosis who had previously received the sofosbuvir/daclatasvir combination. Treatment was safe, with no relevant side-effects reported that led to discontinuation of treatment.
The third and final work of this doctoral thesis was proposed in line with the WHO recommendations on the elimination of the hepatitis C virus by 2030 and given the possibility of making a diagnosis of viral hepatitis in the emergency department. A population-based study was designed through a health strategy of screening for hepatitis C virus infection in the emergency department of the Hospital Universitari Vall d鈥橦ebron. A total of 17,560 adults were screened in the emergency department over two years. The prevalence of HCV antibodies was 3.8% and of active infection 0.7% (detectable HCV RNA), these prevalence rates being three times higher than previously described. This strategy allowed 54% of patients with active hepatitis C to be linked to hepatology consultations. In addition, a cost-effectiveness study of HCV screening strategy versus no screening was performed, showing that ED screening is cost-effective in a similar way to other well-established screening strategies.
In conclusion, this doctoral thesis concludes that hepatitis C infection remains highly relevant as an etiological agent of acute hepatitis. Despite the high efficacy of direct-acting antivirals against hepatitis C virus, there are still a small number of therapeutic failures that can be safely and effectively rescued by the sofosbuvir/velpatasvir/voxilaprevir combination. HCV eradication should be aimed at increasing diagnosis through population-based screening programs. HCV eradication should aim to increase diagnosis through population-based screening programmes. Emergency departments can be settings where screening and linkage strategies can be highly cost-effective.Universitat Aut貌noma de Barcelona. Programa de Doctorat en Medicin
Nuevos horizontes en la epidemiolog铆a, cl铆nica, tratamiento y cribado de la infecci贸n por el virus de la hepatitis C en la era de los antivirales de acci贸n directa
La infecci贸 pel virus de l'hepatitis C ha canviat radicalment despr茅s de l'aparici贸 dels nous antivirals d'acci贸 directa, fet que ha perm猫s plantejar-se fins i tot l'eradicaci贸 de la infecci贸. L'objectiu d'aquesta tesi pret茅n establir nous horitzons cap a la identificaci贸, el cribratge i el maneig de l'hepatitis C des de tres angles diferents com s贸n l'epidemiologia, el tractament i el diagn貌stic. El primer treball d'aquesta tesi doctoral t茅 la intenci贸 de descriure l'etiologia de les hepatitis agudes virals en una cohort d'adults atesos al servei d'urg猫ncies de l'Hospital Vall d'Hebron durant 4 anys. Dels 100 casos d'hepatitis viral, l'hepatitis B continua sent l'etiologia m茅s freq眉ent amb un 28% dels casos, predominant en pacients emigrants de zones sense programes de vacunaci贸 universal. La segona etiologia va ser el virus de l'hepatitis E amb un 18% dels casos, probablement associat a la millora de les t猫cniques diagn貌stiques actuals. Finalment, el virus de l'hepatitis C ocupa la tercera causa i 茅s l'etiologia amb m茅s impacte sanitari condicionant l'ingr茅s de fins a un 76% dels casos. El factor de risc m茅s freq眉ent associat a la infecci贸 per virus hepatitis C van ser les conductes sexuals de risc. Cronificaren un 41% dels pacients, aconseguint tots ells la curaci贸 amb antivirals d'acci贸 directa. Tot i les altes taxes de curaci贸 amb antivirals d'acci贸 directa contra la infecci贸 pel VHC, hi ha un 5% de pacients que hi fracassen. El segon treball va avaluar en una cohort multic猫ntrica espanyola, l'efic脿cia i la seguretat de sofosbuvir/velpatasvir/voxilaprevir en pacients amb hepatitis C cr貌nica. S'hi van incloure 137 pacients que havien fracassat pr猫viament a un tractament amb antivirals d'acci贸 directa. Es va reportar una resposta virol貌gica sostinguda del 95% veient-se que el grau de fibrosi hep脿tica o la pres猫ncia de substitucions associades a resist猫ncies no van impactar sobre la resposta. Els pacients no responedors van ser majorit脿riament genotip 3 amb fibrosi hep脿tica avan莽ada i que havien rebut la combinaci贸 de sofosbuvir/daclatasvir. El tractament va ser segur, no es van reportar efectes secundaris rellevants. En l铆nia amb les recomanacions de l'OMS sobre l'eliminaci贸 del virus de l'hepatitis C l'any 2030, es va plantejar el tercer treball que compon aquesta tesi doctoral. Es va dissenyar un estudi poblacional mitjan莽ant una estrat猫gia de salut de cribratge de la infecci贸 pel virus hepatitis C a les urg猫ncies de l'Hospital Universitari Vall d'Hebron. Es van garbellar 17.560 adults a urg猫ncies durant dos anys. La prevalen莽a d'anticossos anti-VHC va ser de 3,8% i d'infecci贸 activa del 0,7% (ARN del VHC detectable), prevalences tres vegades superiors que a la poblaci贸 general. El 54% dels pacients amb hepatitis C activa es van vincular a consultes d'hepatologia. Aix铆 mateix, es va realitzar un estudi cost-efectivitat de l'estrat猫gia de cribratge del virus hepatitis C concloent que el cribratge a urg猫ncies 茅s cost-efectiu de forma similar a altres estrat猫gies de cribratge ben establertes. Aix铆, doncs, aquesta tesi doctoral conclou que el virus hepatitis C continua sent rellevant com a agent etiol貌gic d'hepatitis aguda mostrant un canvi de paradigma en els pacients i factors de risc associats a aquesta infecci贸. Tot i l'alta efic脿cia dels antivirals d'acci贸 directa contra el virus de l'hepatitis C segueixen existint un redu茂t nombre d'errors terap猫utics que es poden rescatar de manera segura i efectiva mitjan莽ant la combinaci贸 de sofosbuvir/velpatasvir/voxilaprevir. L'eradicaci贸 de l'hepatitis C ha d'encaminar-se a incrementar el diagn貌stic mitjan莽ant programes de cribratge. Els serveis d'urg猫ncies poden ser un escenari on estrat猫gies de cribratge i vinculaci贸 poden ser altament cost-efectives.La infecci贸n por el virus de la hepatitis C ha cambiado radicalmente tras la aparici贸n de los nuevos antivirales de acci贸n directa, hecho que ha permitido hasta plantearse la erradicaci贸n de la infecci贸n. El objetivo de esta tesis pretende establecer nuevos horizontes hacia la identificaci贸n, cribado y manejo de la hepatitis C desde tres 谩ngulos diferentes como son la epidemiolog铆a, el tratamiento y el diagn贸stico. El primer trabajo de esta tesis doctoral tiene la intenci贸n de describir la etiolog铆a de las hepatitis agudas virales en una cohorte de adultos atendidos en el servicio de urgencias del Hospital Vall d'Hebron durante 4 a帽os. De los 100 casos de hepatitis viral, la hepatitis B sigue siendo la etiolog铆a m谩s frecuente con un 28% de los casos, predominando en pacientes emigrantes de zonas sin programas de vacunaci贸n universal. La segunda etiolog铆a fue el virus de la hepatitis E con un 18% de los casos, probablemente asociado a la mejor铆a de las t茅cnicas diagn贸sticas actuales. Finalmente, el virus de la hepatitis C ocupa la tercera causa siendo la etiolog铆a con m谩s impacto sanitario, ingresando hasta un 76% de los casos. El factor de riesgo m谩s frecuente asociado a la infecci贸n por virus hepatitis C fueron las conductas sexuales de riesgo. Cronificaron un 41% de los pacientes, alcanzando todos ellos la curaci贸n con antivirales de acci贸n directa. Pese a las altas tasas de curaci贸n con antivirales de acci贸n directa contra la infecci贸n por el VHC, existe un 5% de pacientes que fracasan a estos. El segundo trabajo evalu贸 en una cohorte multic茅ntrica espa帽ola, la eficacia y seguridad de sofosbuvir/velpatasvir/voxilaprevir en pacientes con hepatitis C cr贸nica. Se incluyeron 137 pacientes que hab铆an fracasado previamente a un tratamiento con antivirales de acci贸n directa. Se report贸 una respuesta virol贸gica sostenida del 95% vi茅ndose que el grado de fibrosis hep谩tica o la presencia de sustituciones asociadas a resistencias no impactaron sobre la respuesta. Los pacientes no respondedores fueron mayoritariamente genotipo 3 con fibrosis hep谩tica avanzada y que hab铆an recibido la combinaci贸n de sofosbuvir/daclatasvir. El tratamiento result贸 ser seguro, no se reportaron efectos secundarios relevantes. En l铆nea con las recomendaciones de la OMS sobre la eliminaci贸n del virus de la hepatitis C en el a帽o 2030 se plante贸 el tercer trabajo que compone esta tesis doctoral. Se dise帽贸 un estudio poblacional a trav茅s de una estrategia de salud de cribado de la infecci贸n por el VHC en las urgencias del Hospital Universitari Vall d'Hebron. Se cribaron 17.560 adultos en urgencias durante dos a帽os. La prevalencia de anticuerpos anti-VHC fue de 3,8% y de infecci贸n activa del 0,7% (ARN del VHC detectable), prevalencias tres veces superiores que en la poblaci贸n general. Se vincularon a consultas de hepatolog铆a el 54% de los pacientes con hepatitis C activa. Asimismo, se realiz贸 un estudio coste-efectividad de la estrategia de cribado del virus hepatitis C concluyendo que el cribado en urgencias es coste-efectivo de forma similar a otras estrategias de cribado bien establecidas. As铆 pues, esta tesis doctoral concluye que el virus hepatitis C sigue siendo relevante como agente etiol贸gico de hepatitis aguda mostrando un cambio de paradigma en los pacientes y factores de riesgo asociados a dicha infecci贸n. Pese a la alta eficacia de los antivirales de acci贸n directa contra el virus de la hepatitis C siguen existiendo un reducido n煤mero de fallos terap茅uticos que pueden rescatarse de forma segura y efectiva mediante la combinaci贸n de sofosbuvir/velpatasvir/voxilaprevir. La erradicaci贸n de la hepatitis C debe encaminarse a incrementar el diagn贸stico a trav茅s de programas de cribado. Los servicios de urgencias pueden ser un escenario en donde estrategias de cribado y vinculaci贸n pueden ser altamente coste-efectivas.Hepatitis C virus infection has undergone a radical change in recent years. The emergence of new direct-acting antivirals has made possible to consider strategies for eradicating the infection. The aim of this thesis is to establish new horizons towards the identification, screening, and management of hepatitis C from three different angles such as epidemiology, treatment, and screening. The first work of this doctoral thesis aims to describe the aetiology of acute viral hepatitis in a cohort of adults treated in the emergency department of the Hospital Vall d'Hebron over a period of 4 years. Of the 100 cases recorded, hepatitis B remains the most frequent aetiology with 28% of cases, predominantly in migrant patients from areas without universal vaccination programmes. Hepatitis E virus was described as the second most frequent aetiology with 18% of cases, probably associated with the improvement of current diagnostic techniques. Finally, hepatitis C virus was the third cause, being the aetiology with the highest health impact, accounting for 76% of cases. The most frequent risk factor associated with HCV infection was risky sexual behaviour. Chronic disease progression was observed in 41% of patients, all of whom were cured with direct-acting antivirals. Despite the high cure rates with direct-acting antivirals against hepatitis C virus infection, there are 5% of patients who fail these antivirals. The second study in this dissertation evaluated the efficacy and safety of the combination sofosbuvir/velpatasvir/voxilaprevir in patients with chronic hepatitis C in a Spanish multicentre cohort. A total of 137 patients who had previously failed treatment with direct-acting antivirals were included. A 95% sustained virologic response was reported, showing that the degree of liver fibrosis or the presence of resistance-associated substitutions did not impact response. Non-responders were mostly genotype 3 patients with advanced liver fibrosis or cirrhosis who had previously received the sofosbuvir/daclatasvir combination. Treatment was safe, with no relevant side-effects reported that led to discontinuation of treatment. The third and final work of this doctoral thesis was proposed in line with the WHO recommendations on the elimination of the hepatitis C virus by 2030 and given the possibility of making a diagnosis of viral hepatitis in the emergency department. A population-based study was designed through a health strategy of screening for hepatitis C virus infection in the emergency department of the Hospital Universitari Vall d'Hebron. A total of 17,560 adults were screened in the emergency department over two years. The prevalence of HCV antibodies was 3.8% and of active infection 0.7% (detectable HCV RNA), these prevalence rates being three times higher than previously described. This strategy allowed 54% of patients with active hepatitis C to be linked to hepatology consultations. In addition, a cost-effectiveness study of HCV screening strategy versus no screening was performed, showing that ED screening is cost-effective in a similar way to other well-established screening strategies. In conclusion, this doctoral thesis concludes that hepatitis C infection remains highly relevant as an etiological agent of acute hepatitis. Despite the high efficacy of direct-acting antivirals against hepatitis C virus, there are still a small number of therapeutic failures that can be safely and effectively rescued by the sofosbuvir/velpatasvir/voxilaprevir combination. HCV eradication should be aimed at increasing diagnosis through population-based screening programs. HCV eradication should aim to increase diagnosis through population-based screening programmes. Emergency departments can be settings where screening and linkage strategies can be highly cost-effective
Table_1_Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention.DOCX
BackgroundAround 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model.MethodsThe Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods.InterventionBBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI.ResultsTwo years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period.ConclusionsImplementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.</p