Based on WHO targets, model of care improves management of hepatitis C in dialysis centers
A collaborative approach between nephrologists and gastroenterologists has improved the diagnosis and treatment of hepatitis C virus in 31 dialysis centers in Changhua County, Taiwan.
Increasing rates of diagnosis and treatment close to levels set by WHO, according to Tsung-Hui Hu, MD, PhD, from Kaohsiung Memorial Hospital Chang Gung and colleagues.
“This study shows how to provide a new model of collaborative county-wide treatment delivery care for treatment [hepatitis C virus] HCV infected [end-stage renal disease] ESRD patients in Taiwan. We achieved a 98.3% diagnosis rate and 89.1% treatment coverage for dialysis patients across the county in a short time, which met the criteria for HCV micro-elimination, ”said wrote Hu and his colleagues.
According to the researchers, the introduction of direct-acting antivirals (DAAs) as a treatment for hepatitis C has prompted the WHO to start developing strategies to eliminate the virus by 2030. At the same time, the Taiwanese government is seeking to treat 80% of hepatitis C patients by 2025.
“Achieving elimination of HCV is a big challenge because there is a great variation in the pattern of distribution of cases and subpopulations,” the researchers wrote. “The micro-elimination approach, which focuses on treating smaller, targeted high-risk subpopulations, has been proposed as an effective way to control HCV.” Although several micro-elimination programs have been developed, most of them have been implemented in high-income countries. countries where HCV predominates among vulnerable populations. In contrast, few programs have targeted high-risk populations in health care facilities, although HCV infections associated with health care in these facilities are widespread, particularly in middle and low-income countries.
With hemodialysis facilities being “high risk environments” for the virus, Hu and his colleagues developed a model of care that was administered to a total of 3,657 patients. The approach focused on the following:
- collaboration between gastroenterologists and nephrologists;
- unlimited access to DAAs;
- nurse-led case management;
- medical transport; and
“Outcome measures included quality indicators relating to six stages of HCV care ranging from screening for HCV to full treatment and recovery from DAA treatment,” the researchers wrote.
The DAA treatment initiation rate and completion rate were 88.9% and 94%, respectively.
The results showed that the collaborative care model led to a 96% cure rate, with no occurrence of virologic failure.
The researchers also observed an improvement in cumulative treatment ratios for patients with chronic hepatitis C virus infection: ratios increased from 5.3% before interferon treatment in 2017 to 25.6% after the restricted provision of DAAs in 2017 to 2018. After the introduction of universal access to DAAs in 2019, the cumulative salary ratio increased to 89.1%.
“Although the elimination of HCV [in] Single center cases of ESRD have been reported, there is currently no published real world data on the effectiveness of DAA treatment for HCV elimination in patients with ESRD at the level of the people, ”wrote Hu and his colleagues. “As expected, most patients achieved SVR12 with acceptable treatment tolerance. The high cure rate achieved in the present study also confirmed the feasibility and effectiveness of the “treatment as prevention” strategy in high risk groups. The key elements contributing to the success of the current program are potentially relevant for expanding the treatment strategy and achieving the WHO goals for HCV elimination. “