Aleman Soo, Söderholm Jonas, Büsch Katharina, Kövamees Jan, Duberg Ann-Sofi
Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Liver Int. 2020 Aug;40(8):1832-1840. doi: 10.1111/liv.14469. Epub 2020 Jun 14.
Previous studies on hepatitis C cascade of care have been mainly focused on diagnosis and treatment rate, while less attention has been given to patients lost to follow-up (LTFU) after diagnosis. Analyses of this latter issue on population level are missing.
In this nationwide study of people with HCV, we aimed to estimate the proportion LTFU after HCV diagnosis, characterize them, and analyze their other healthcare contacts.
Patients diagnosed with chronic HCV in the Swedish National Patient Register during 2001-2011 and still alive December 31, 2013, were included. The number of cured patients without need of follow-up was estimated. Visits to HCV specialist care during 2012-2013 were analysed. For those LTFU, other specialist care contacts were studied.
In total 29 217 patients were included, with 24 733 with need of HCV care. 61% (n = 15 007) of them were LTFU from HCV care in 2012-2013 and 58% did not attend HCV care during the second year after HCV diagnosis. The departments of surgery/orthopaedic or psychiatry/dependency were the most common other non-primary healthcare contacts. Predictors for LTFU were young age, male sex, low education, presence of psychiatric/dependency diagnosis, unmarried and longer duration since diagnosis of HCV.
This study showed that almost two-thirds of patients were LTFU after HCV diagnosis, with frequent occurrence early after diagnosis. Efforts to link patients back to HCV care, in combination with early and easy access to HCV treatment and harm reduction, are necessary to reach the HCV elimination goal.
先前关于丙型肝炎治疗流程的研究主要集中在诊断和治疗率上，而对诊断后失访患者的关注较少。目前尚缺乏对这一问题的人群水平分析。
在这项针对全国丙型肝炎患者的研究中，我们旨在估计丙型肝炎诊断后的失访比例，对失访患者进行特征描述，并分析他们的其他医疗接触情况。
纳入2001年至2011年期间在瑞典国家患者登记册中被诊断为慢性丙型肝炎且在2013年12月31日仍存活的患者。估计已治愈且无需随访的患者数量。分析2012年至2013年期间丙型肝炎专科护理的就诊情况。对于失访患者，研究他们的其他专科护理接触情况。
共纳入29217例患者，其中24733例需要丙型肝炎护理。在2012年至2013年期间，这些患者中有61%（n = 15007）失访丙型肝炎护理，58%在丙型肝炎诊断后的第二年未接受丙型肝炎护理。外科/骨科或精神科/成瘾科是最常见的其他非初级医疗接触科室。失访的预测因素包括年轻、男性、低教育水平、存在精神科/成瘾诊断、未婚以及丙型肝炎诊断后的病程较长。
本研究表明，近三分之二的患者在丙型肝炎诊断后失访，且在诊断后早期频繁发生。为实现丙型肝炎消除目标，有必要努力使患者重新接受丙型肝炎护理，同时确保早期且便捷地获得丙型肝炎治疗及减少危害。
