Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Vienna HIV & Liver Study Group, Vienna, Austria.
Wien Klin Wochenschr. 2021 May;133(9-10):452-460. doi: 10.1007/s00508-020-01790-y. Epub 2020 Dec 22.
Despite the availability of effective and well-tolerated direct acting antivirals (DAAs) against hepatitis C virus (HCV) infection, a substantial number of HCV patients remain untreated. Novel strategies targeting HCV patients with poor adherence are urgently needed to enable HCV elimination.
We implemented a physician-operated HCV hotline (HCV-Phone) that was promoted within the patient community and referral networks. Previously diagnosed HCV patients were contacted via the HCV-Phone and offered low-barrier access to DAA therapy. Patients/referring physicians could directly call or send messages to the HCV-Phone. The HCV-Phone related and unrelated visits as well as DAA treatment initiations throughout 2019 were documented. Patients were followed until October 2020. This study analyzed treatment initiation, adherence to scheduled visits and outcomes in patients in whom management was assisted by the HCV-Phone.
Out of 98 patient contacts via the HCV-Phone 74 attended treatment assessment at our clinic. While 15 (20%) patients were HCV-RNA negative and 1 (1%) patient did not initiate therapy, 58 patients were recruited for DAA therapy via the HCV-Phone. A total of 21 additional patients who started DAAs without HCV-Phone assistance required the use of the HCV-Phone infrastructure later on during treatment, resulting in a total of 79 HCV-Phone related DAA therapies. The poor adherence of patients previously diagnosed with HCV at our clinic is underlined by the long duration from HCV diagnosis to DAA therapy of median 37.0 months (IQR 2.7-181.1 months). A total of 55 (70%) HCV patients achieved a sustained virological response (SVR), 5 (6%) discontinued therapy, 1 (1%) had a reinfection, while 10 (13%) and 8 (10%) patients were lost during DAA therapy or follow-up, respectively.
The implementation of a physician-operated phone hotline for patients with HCV infection facilitated treatment initiation in an HCV population with poor adherence. Mainly due to losses to follow-up, the SVR rate remained suboptimal with 70%.
尽管已有针对丙型肝炎病毒 (HCV) 感染的有效且耐受性良好的直接作用抗病毒药物 (DAA)，但仍有大量 HCV 患者未接受治疗。迫切需要针对依从性差的 HCV 患者的新策略，以实现 HCV 的消除。
我们实施了一个由医生运营的 HCV 热线 (HCV-Phone)，并在患者群体和转诊网络中进行了推广。通过 HCV-Phone 联系之前诊断出的 HCV 患者，并为他们提供低门槛的 DAA 治疗途径。患者/转诊医生可以直接拨打或向 HCV-Phone 发送信息。记录了 2019 年全年 HCV-Phone 相关和不相关的就诊次数以及开始 DAA 治疗的情况。对患者进行随访，直至 2020 年 10 月。本研究分析了通过 HCV-Phone 协助管理的患者的治疗启动、就诊依从性和结局。
通过 HCV-Phone 与 98 名患者取得联系，其中 74 名患者在我们的诊所进行了治疗评估。15 名（20%）患者 HCV-RNA 阴性，1 名（1%）患者未开始治疗，通过 HCV-Phone 招募了 58 名患者接受 DAA 治疗。21 名未经 HCV-Phone 协助开始 DAA 治疗的患者在治疗过程中需要使用 HCV-Phone 基础设施，因此共进行了 79 次 HCV-Phone 相关的 DAA 治疗。在我们的诊所之前诊断出 HCV 的患者的依从性很差，从 HCV 诊断到 DAA 治疗的中位时间为 37.0 个月（IQR 2.7-181.1 个月）。共有 55 名（70%）HCV 患者获得持续病毒学应答 (SVR)，5 名（6%）停止治疗，1 名（1%）再次感染，10 名（13%）和 8 名（10%）患者分别在 DAA 治疗或随访期间失访。
实施由医生运营的 HCV 患者热线电话，为依从性差的 HCV 患者提供了治疗启动的途径。主要由于失访，SVR 率仍不理想，为 70%。
