Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Faculty of Internal Medicine and Hepatitis Research Center, College of Medicine, and Center for Cohort Study,Kaohsiung Medical University,Kaohsiung,Taiwan.
Gut. 2021 Dec;70(12):2349-2358. doi: 10.1136/gutjnl-2020-323277. Epub 2020 Dec 10.
HCV prevails in uremic haemodialysis patients. The current study aimed to achieve HCV microelimination in haemodialysis centres through a comprehensive outreach programme.
The ERASE-C Campaign is an outreach programme for the screening, diagnosis and group treatment of HCV encompassing 2323 uremic patients and 353 medical staff members from 18 haemodialysis centres. HCV-viremic subjects were linked to care for directly acting antiviral therapy or received on-site sofosbuvir/velpatasvir therapy. The objectives were HCV microelimination (>80% reduction of the HCV-viremic rate 24 weeks after the end of the campaign in centres with ≥90% of the HCV-viremic patients treated) and 'No-C HD' (no HCV-viremic subjects at the end of follow-up).
At the preinterventional screening, 178 (7.7%) uremic patients and 2 (0.6%) staff members were HCV-viremic. Among them, 146 (83.9%) uremic patients received anti-HCV therapy (41 link-to-care; 105 on-site sofosbuvir/velpatasvir). The rates of sustained virological response (SVR12, undetectable HCV RNA 12 weeks after the end of treatment) in the full analysis set and per-protocol population were 89.5% (94/105) and 100% (86/86), respectively, in the on-site treatment group, which were comparable with the rates of 92.7% (38/41) and 100% (38/38), respectively, in the link-to-care group. Eventually, the HCV-viremic rate decreased to 0.9% (18/1,953), yielding an 88.3% reduction from baseline. HCV microelimination and 'No-C HD' were achieved in 92.3% (12/13) and 38.9% (7/18) of the haemodialysis centres, respectively.
Outreach strategies with mass screenings and on-site group treatment greatly facilitated HCV microelimination in the haemodialysis population.
NCT03803410 and NCT03891550.
HCV 在尿毒症血液透析患者中普遍存在。本研究旨在通过综合外展计划在血液透析中心实现 HCV 微清除。
ERASE-C 运动是一项针对 HCV 的外展计划，涵盖了 2323 名尿毒症患者和 18 个血液透析中心的 353 名医务人员，包括筛查、诊断和集体治疗。HCV 病毒血症患者与直接作用抗病毒治疗联系在一起，或在现场接受索磷布韦/维帕他韦治疗。目标是 HCV 微清除（>80%的 HCV 病毒血症率降低，在 90%以上的 HCV 病毒血症患者接受治疗的中心，在活动结束后 24 周）和“无 HCV 血液透析”（在随访结束时无 HCV 病毒血症患者）。
在干预前筛查中，178 名（7.7%）尿毒症患者和 2 名（0.6%）工作人员 HCV 病毒血症。其中，146 名（83.9%）尿毒症患者接受抗 HCV 治疗（41 例链接至护理；105 例现场索磷布韦/维帕他韦）。在全分析集和按方案人群中，现场治疗组的持续病毒学应答（SVR12，治疗结束后 12 周 HCV RNA 不可检测）率分别为 89.5%（94/105）和 100%（86/86），与链接至护理组的 92.7%（38/41）和 100%（38/38）的率相当。最终，HCV 病毒血症率降至 0.9%（18/1953），基线时降低了 88.3%。在 13 个血液透析中心中的 92.3%（12/13）和 38.9%（7/18）分别实现了 HCV 微清除和“无 HCV 血液透析”。
大规模筛查和现场集体治疗的外展策略极大地促进了血液透析人群中 HCV 的微清除。
NCT03803410 和 NCT03891550。
