Opportunistic assessment and treatment of people with hepatitis C virus infection admitted to hospital for other reasons: A prospective cohort study |
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| Affiliation: | 1. Clinical Research Support Center, Mie University Hospital, Mie, Japan;2. Ageo Central General Hospital, Ageo, Saitama, Japan;3. Graduate School of Medicine, Kyoto University, Kyoto, Japan;4. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto and National Cerebral and Cardiovascular Center, Suita, Osaka, Japan;5. Fukuoka Sanno Hospital, Fukuoka, Japan;6. International University of Health and Welfare, Ohtawara, Japan;7. Division of Cardiology, Department of Medicine, Faculty of Medicine, Kinki University, Osaka, Japan;8. Life Science & Medical Bioscience, Faculty of Science and Engineering, Waseda University, Tokyo, Japan;9. Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan;10. Clinical Data & Biostatistics Department, R&D Division, Daiichi Sankyo Co., Ltd., Tokyo, Japan;11. Division of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan;1. University Hospital Jean Minjoz, EA3920, Besançon, France;2. Assistance Publique — Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France;3. Hôpital Nord, Marseille, France;4. Clinique de Fontaine, Fontaine-lès-Dijon, France;5. Groupe Hospitalier Pitié-Salpêtrière, Paris, France;6. University Hospital Gabriel Montpied, Clermont Ferrand, France;7. Centre Hospitalier Général, Vichy, France;8. Hôpital Arnaud de Villeneuve, Montpellier, France;9. Clinique mutualiste des Eaux claires, Grenoble, France;10. University Hospital Rangueil, Toulouse, France;11. APHP-Hôpital Saint Antoine, Paris, France;12. INSERM U-698, UPMC, Paris 06, Paris, France;1. Terrence Donnelly Heart Centre, St Michael''s Hospital, University of Toronto, Toronto, ON, Canada;2. Duke Clinical Research Institute, Durham, NC, USA;3. Canadian Heart Research Centre, Toronto, ON, Canada;4. Eli Lilly Canada Inc., Toronto, ON, Canada;5. Mazankowski Alberta Heart Institute, University of Alberta, Canadian VIGOUR Centre, Edmonton, AB, Canada;6. Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, QC, Canada;7. Eli Lilly and Company, Indianapolis, IN, United States;8. Prairie Vascular Research Network, Regina Qu''Appelle Health Region, Regina, SK, Canada;9. Rouge Valley Health System, Toronto, ON, Canada;10. Cardiac Sciences Program, St Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada;11. Royal Alexandra Hospital, Edmonton, AB, Canada;12. St. Mary''s General Hospital, Kitchener, ON, Canada;13. Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada;14. Hôpital du Sacré-Coeur de Montréal, Université de Montréal, QC, Canada;15. Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada;p. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada;1. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC;2. Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN;3. St Luke''s Mid America Heart Institute, Kansas City, MO;4. Lilly USA, LLC, Indianapolis, IN;5. Daiichi Sankyo, Inc, Parsippany, NJ;6. Denver Veterans Affairs Medical Center, Denver, CO |
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| Abstract: | BackgroundIt will be essential to find novel ways to access, diagnose and treat people with Hepatitis C Virus (HCV) infection in Australia to achieve HCV elimination.AimWe assessed the effectiveness of opportunistic HCV assessment and antiviral treatment in patients admitted to hospital for other reasons.MethodsPatients with HCV infection were referred from inpatient services at a tertiary referral centre in Sydney. Patients were assessed for HCV treatment with transient elastography (TE), HCV genotype and a clinical assessment and a summary letter was generated for all patients with a general practitioner (GP). Patients were offered treatment commencement at hospital discharge or after discharge with their GP, the infectious diseases clinic or with a gastroenterologist if they had cirrhosis. The primary outcome was the proportion of eligible patients who commenced treatment. We also undertook an intention to treat (ITT), modified intent to treat (mITT) analysis for virologic outcome (SVR12) and per protocol cure rates. An assessment of potential efficiency gains was undertaken.ResultsA total of 100 patients with a positive HCV antibody test were enrolled, of whom 70 were viraemic. The cohort included a high proportion of people who currently or previously injected drugs, indigenous patients and people previously lost to follow-up from other services. Treatment was initiated in 46 (66%) patients. The ITT was 80.4% (37/46) and mITT rate was 84.1% (37/44).The per-protocol SVR12 rate was 94.9%. Two subjects with genotype 3 and cirrhosis failed treatment, two subjects died and five were lost to follow up. The key barrier to uptake of DAA was incomplete assessment. Key inefficiencies of this model of care included referral of non-viraemic subjects, limited TE access and virologic test turnaround times.ConclusionThis model of care can complement the current efforts to increase HCV treatment in the community for those who do not access care elsewhere or are lost to follow-up. |
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| Keywords: | Hepatitis C Inpatient model of care Linkage of care Direct acting antivirals |
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