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Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil

BACKGROUND: Hepatitis C virus (HCV) is defined as a public health problem by the World Health Organization (WHO) and since then has defined targets through the HCV elimination. The HCV cascade of care highlights the progress towards these goals and essential interventions that need to be delivered a...

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Autores principales: Vaucher, Manoela Badinelli, Silva, Camila Ubirajara, Varella, Ivana Rosângela Santos, Kim, Arthur Yu-Shin, Kliemann, Dimas Alexandre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494563/
https://www.ncbi.nlm.nih.gov/pubmed/37701918
http://dx.doi.org/10.4254/wjh.v15.i8.973
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author Vaucher, Manoela Badinelli
Silva, Camila Ubirajara
Varella, Ivana Rosângela Santos
Kim, Arthur Yu-Shin
Kliemann, Dimas Alexandre
author_facet Vaucher, Manoela Badinelli
Silva, Camila Ubirajara
Varella, Ivana Rosângela Santos
Kim, Arthur Yu-Shin
Kliemann, Dimas Alexandre
author_sort Vaucher, Manoela Badinelli
collection PubMed
description BACKGROUND: Hepatitis C virus (HCV) is defined as a public health problem by the World Health Organization (WHO) and since then has defined targets through the HCV elimination. The HCV cascade of care highlights the progress towards these goals and essential interventions that need to be delivered along this continuum care. AIM: To document the treatment cascade for patients with HCV infection at the Hospital Nossa Senhora da Conceição (HNSC), defining the percentage of antibody-positive patients who collected molecular biology tests (polymerase chain reaction), attended outpatient clinic assistance, underwent treatment, and achieved a virologic cure termed sustained virologic response (SVR). METHODS: With the retrospective cohort design, patients diagnosed with HCV infection in the period between January 1, 2015 and December 31, 2020 were included. Data from HCV notification forms, electronic medical records, Computerized Laboratory Environment Manager System, and Medicine Administration System (evaluation of special medications) were collected in 2022 and all information up to that period was considered. The data were analyzed with IBM SPSS version 25, and Poisson regression with robust simple variance was performed for analysis of variables in relation to each step of the cascade. Variables with P < 0.20 were included in the multivariate analysis with P < 0.05 considered significant. Pearson’s chi-square test was applied to compare the groups of patients who persisted in follow-up at the HNSC and who underwent follow-up at other locations. RESULTS: Results were lower than expected by the WHO with only 49% of candidates receiving HCV treatment and only 29% achieving SVR, despite the 98% response rate to direct acting antivirals documented by follow-up examination. The city of origin and the place of follow-up were the variables associated with SVR and all other endpoints. When comparing the cascade of patients who remained assisted by the HNSC vs external patients, we observed superior data for HNSC patients in the SVR. Patients from the countryside and metropolitan region were mostly assisted at the HNSC and the specialized and continuous care provided at the HNSC was associated with superior results, although the outcomes remain far from the goals set by the WHO. CONCLUSION: With the elaboration of the HCV cascade of care using local data, it was possible to stratify and evaluate risk factors associated with losses between each step of the cascade, to inform new strategies to guide elimination efforts in the future.
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spelling pubmed-104945632023-09-12 Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil Vaucher, Manoela Badinelli Silva, Camila Ubirajara Varella, Ivana Rosângela Santos Kim, Arthur Yu-Shin Kliemann, Dimas Alexandre World J Hepatol Retrospective Cohort Study BACKGROUND: Hepatitis C virus (HCV) is defined as a public health problem by the World Health Organization (WHO) and since then has defined targets through the HCV elimination. The HCV cascade of care highlights the progress towards these goals and essential interventions that need to be delivered along this continuum care. AIM: To document the treatment cascade for patients with HCV infection at the Hospital Nossa Senhora da Conceição (HNSC), defining the percentage of antibody-positive patients who collected molecular biology tests (polymerase chain reaction), attended outpatient clinic assistance, underwent treatment, and achieved a virologic cure termed sustained virologic response (SVR). METHODS: With the retrospective cohort design, patients diagnosed with HCV infection in the period between January 1, 2015 and December 31, 2020 were included. Data from HCV notification forms, electronic medical records, Computerized Laboratory Environment Manager System, and Medicine Administration System (evaluation of special medications) were collected in 2022 and all information up to that period was considered. The data were analyzed with IBM SPSS version 25, and Poisson regression with robust simple variance was performed for analysis of variables in relation to each step of the cascade. Variables with P < 0.20 were included in the multivariate analysis with P < 0.05 considered significant. Pearson’s chi-square test was applied to compare the groups of patients who persisted in follow-up at the HNSC and who underwent follow-up at other locations. RESULTS: Results were lower than expected by the WHO with only 49% of candidates receiving HCV treatment and only 29% achieving SVR, despite the 98% response rate to direct acting antivirals documented by follow-up examination. The city of origin and the place of follow-up were the variables associated with SVR and all other endpoints. When comparing the cascade of patients who remained assisted by the HNSC vs external patients, we observed superior data for HNSC patients in the SVR. Patients from the countryside and metropolitan region were mostly assisted at the HNSC and the specialized and continuous care provided at the HNSC was associated with superior results, although the outcomes remain far from the goals set by the WHO. CONCLUSION: With the elaboration of the HCV cascade of care using local data, it was possible to stratify and evaluate risk factors associated with losses between each step of the cascade, to inform new strategies to guide elimination efforts in the future. Baishideng Publishing Group Inc 2023-08-27 2023-08-27 /pmc/articles/PMC10494563/ /pubmed/37701918 http://dx.doi.org/10.4254/wjh.v15.i8.973 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Cohort Study
Vaucher, Manoela Badinelli
Silva, Camila Ubirajara
Varella, Ivana Rosângela Santos
Kim, Arthur Yu-Shin
Kliemann, Dimas Alexandre
Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil
title Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil
title_full Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil
title_fullStr Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil
title_full_unstemmed Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil
title_short Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil
title_sort stages of care for patients with chronic hepatitis c at a hospital in southern brazil
topic Retrospective Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494563/
https://www.ncbi.nlm.nih.gov/pubmed/37701918
http://dx.doi.org/10.4254/wjh.v15.i8.973
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