Granozzi Bianca, Guardigni Viola, Badia Lorenzo, Rosselli Del Turco Elena, Zuppiroli Alberto, Tazza Beatrice, Malosso Pietro, Pieralli Stefano, Viale Pierluigi, Verucchi Gabriella
Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy.
Open Group Society Coop. Soc. Onlus, 40139 Bologna, Italy.
J Clin Med. 2021 Oct 26;10(21):4955. doi: 10.3390/jcm10214955.
People who inject drugs (PWID) and homeless people represent now a large reservoir of Hepatitis C virus (HCV) infection. However, Hepatis C elimination programs can barely reach these subgroups of patients. We aimed to evaluate and compare the retention in care among these difficult-to-treat patients when managed for HCV in hospital or in an out-of-hospital setting.
In our retrospective study, we categorized the included patients (PWID and homeless persons) into two groups according to whether anti-HCV treatment was offered and provided in a hospital or an out-of-hospital setting. We run logistic regressions to evaluate factors associated with retention in care (defined as the completion of direct antiviral agents (DAAs) therapy).
We included 56 patients in our study: 27 were in the out-of-hospital group. Overall, 33 patients completed DAAs therapy. A higher rate of retention in care was observed in the out-of-hospital group rather than in-hospital group ( = 0.001). At the univariate analysis, retention in care was associated with the out-of-hospital management ( = 0.002) and with a shorter time between the first visit and the scheduled start of DAAs ( = 0.003).
The choice of treatment models that can better adapt to difficult-to-treat populations, such as an out-of-hospital approach, will be important for achieving the eradication of HCV infection.
注射吸毒者和无家可归者如今是丙型肝炎病毒（HCV）感染的一大传染源。然而，丙型肝炎消除计划几乎难以覆盖这些患者亚群。我们旨在评估和比较在医院或院外环境中对这些难以治疗的患者进行HCV管理时的治疗留存率。
在我们的回顾性研究中，根据抗HCV治疗是在医院还是院外环境中提供，将纳入的患者（注射吸毒者和无家可归者）分为两组。我们进行逻辑回归分析，以评估与治疗留存率相关的因素（定义为直接抗病毒药物（DAA）治疗的完成情况）。
我们的研究纳入了56名患者：27名在院外组。总体而言，33名患者完成了DAA治疗。院外组的治疗留存率高于院内组（P = 0.001）。在单因素分析中，治疗留存率与院外管理（P = 0.002）以及首次就诊与预定开始DAA治疗之间的时间较短（P = 0.003）相关。
选择能够更好地适应难以治疗人群的治疗模式，如院外治疗方法，对于实现HCV感染的根除至关重要。
