Yoo Eric R, Perumpail Ryan B, Cholankeril George, Jayasekera Channa R, Ahmed Aijaz
Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
J Clin Transl Hepatol. 2017 Jun 28;5(2):130-133. doi: 10.14218/JCTH.2016.00059. Epub 2017 Mar 26.
In the United States, the fight to eradicate hepatitis C virus (HCV) infection has been ongoing for many years, but the results have been less than ideal. Historically, patients with chronic hepatitis C (CHC) were treated with interferon-based regimens, which were associated with frequent adverse effects, suboptimal response rates, and long durations of treatment - of up to 48 weeks. Expertise from specialist-physicians, such as hepatologists and gastroenterologists, was needed to closely follow patients on these medications so as to monitor laboratory values and manage adverse effects. However, the emergence of direct-acting antiviral (DAA) agents against HCV infection have heralded outstanding progress in terms of safety, tolerability, lack of adverse effects, efficacy, and truncated duration of therapy - 12 weeks or less - thereby making the need for close monitoring by specialist-physicians obsolete. With the recent approval of DAA agents by the Food and Drug Administration, the treatment model for CHC no longer relies on the limited number of specialist-physicians, which represented a major barrier to treatment access in the past, especially in underserved areas of the United States. We propose and share our experiences in adapting a task-shifting treatment model, one that utilizes a relatively larger pool of non-specialist healthcare providers, such as nursing staff (medical assistants, vocational licensed nurses, registered nurses, etc.) and advanced practice providers (nurse practitioners and physician assistants), to perform a variety of important clinical functions in an effort to make DAA-based antiviral therapy widely available against HCV infection. Most recently, task-shifting was implemented by the United States and World Health Organization in the fight against the human immunodeficiency virus and showed encouraging results. Based on our experiences in implementing this model at our outreach clinics, the majority of HCV-infected patients treated with DAA agents can be easily monitored by non-specialist healthcare providers and physician extenders. Task-shifting can effectively address one of the major rate-limiting factors in expanding treatment access for HCV infection.
在美国，根除丙型肝炎病毒（HCV）感染的斗争已经持续多年，但结果并不理想。从历史上看，慢性丙型肝炎（CHC）患者接受基于干扰素的治疗方案，这些方案常伴有不良反应、疗效欠佳以及长达48周的治疗时间。需要肝病专家和胃肠病专家等专科医生的专业知识来密切跟踪服用这些药物的患者，以便监测实验室指标并处理不良反应。然而，针对HCV感染的直接抗病毒药物（DAA）的出现，在安全性、耐受性、无不良反应、疗效以及缩短治疗疗程（12周或更短）方面取得了显著进展，从而使专科医生密切监测的必要性不再存在。随着食品药品监督管理局最近批准了DAA药物，CHC的治疗模式不再依赖数量有限的专科医生，而在过去，这是治疗可及性的一个主要障碍，尤其是在美国医疗服务不足的地区。我们提出并分享我们在采用任务转移治疗模式方面的经验，该模式利用相对更多的非专科医疗服务提供者，如护理人员（医疗助理、职业执照护士、注册护士等）和高级执业提供者（执业护士和医师助理），来执行各种重要的临床功能，以使基于DAA的抗病毒治疗能够广泛用于HCV感染。最近，美国和世界卫生组织在抗击人类免疫缺陷病毒的斗争中实施了任务转移，并取得了令人鼓舞的成果。基于我们在门诊诊所实施该模式的经验，大多数接受DAA药物治疗的HCV感染患者可以由非专科医疗服务提供者和医师助理轻松监测。任务转移可以有效解决扩大HCV感染治疗可及性的一个主要限速因素。
