32 research outputs found
We know DAAs work, so now what?:Simplifying models of care to enhance the hepatitis C cascade
Globally, some 71 million people are chronically
infected with hepatitis C virus (HCV). Marginalised populations,
particularly people who inject drugs (PWID), have low testing,
linkage-to-care and treatment rates for HCV. Several models of
care (MoCs) and service delivery interventions have the
potential to improve outcomes across the HCV cascade of care,
but much of the relevant research was carried out when
interferon-based treatment was the standard of care. Often it
was not practical to scale up these earlier models and
interventions because the clinical care needs of patients taking
interferon-based regimens imposed too much of a financial and
human resource burden on health systems. Despite the adoption of
highly effective, all-oral direct-acting antiviral (DAA)
therapies in recent years, approaches to HCV testing and
treatment have evolved slowly and often remain rooted in earlier
paradigms. The effectiveness of DAAs allows for simpler
approaches and has encouraged countries where the drugs are
widely available to set their sights on the ambitious World
Health Organization (WHO) HCV elimination targets. Since a large
proportion of chronically HCV-infected people are not currently
accessing treatment, there is an urgent need to identify and
implement existing simplified MoCs that speak to specific
populations' needs. This article aims to: 1) review the evidence
on MoCs for HCV; and 2) distil the findings into recommendations
for how stakeholders can simplify the path taken by chronically
HCV-infected individuals from testing to cure and subsequent
care and monitoring
Effectiveness of a Decentralized Hub and Spoke Model for the Treatment of Hepatitis C Virus in a Federally Qualified Health Center
Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs.
The Hepatitis C Virus Care Continuum: Linkage to Hepatitis C Virus Care and Treatment Among Patients at an Urban Health Network, Philadelphia, PA
Improving care and treatment for persons infected with hepatitis C virus (HCV) can reduce HCV-related morbidity and mortality. Our primary objective was to examine the HCV care continuum among patients receiving care at five federally qualified health centers (FQHCs) in Philadelphia, PA, where a testing and linkage to care program had been established. Among the five FQHCs, one served a homeless population, two served public housing residents, one served a majority Hispanic population, and the last, a "test and treat" site, also provided HCV treatment to patients. We analyzed data from electronic health records of patients tested for HCV antibody from 2012 to 2016 and calculated the percentage of patients across nine steps of the HCV care continuum ranging from diagnosis to cure. We further explored factors associated with successful patient navigation through two steps of the continuum using multivariable logistic regression. Of 885 chronically infected patients, 92.2% received their RNA-positive result, 82.7% were referred to an HCV provider, 69.4% were medically evaluated by the provider, 55.3% underwent liver disease staging, 15.0% initiated treatment, 12.0% completed treatment, 8.7% were assessed for sustained virologic response (SVR), and 8.0% achieved SVR. Regression results revealed that test and treat site patients were significantly more likely to be medically evaluated (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.82-4.17) and to undergo liver disease staging (aOR, 1.92; 95% CI, 1.02-2.86) than patients at the other FQHCs combined. Conclusion: In this US urban setting, over two thirds of HCV-infected patients were linked to care; although treatment uptake was low overall, it was highest at the test and treat site; scaling up treatment services in HCV testing settings will be vital to improve the HCV care continuum