质量改进以评估和提供慢性丙型肝炎产后治疗。
Quality improvement to evaluate and provide treatment for chronic hepatitis C postpartum.
出版信息
J Am Pharm Assoc (2003). 2022 May-Jun;62(3):864-869. doi: 10.1016/j.japh.2021.12.006. Epub 2021 Dec 18.
BACKGROUND
Chronic hepatitis C virus (HCV) infections are increasing among reproductive age individuals. Direct acting antivirals (DAAs) can cure HCV, but the use of DAAs is not currently recommended during pregnancy and breastfeeding. Individuals with HCV commonly have inadequate prenatal and postnatal care.
OBJECTIVES
The purpose of our study was to demonstrate the success of a quality improvement program to increase evaluation during pregnancy and ensuring access to DAA treatment medication during the postpartum period for individuals with chronic HCV to achieve cure 12 weeks after completing therapy. The primary outcome was documented HCV cure rate compared among individuals who received immediate treatment with DAA after delivery or after weaning or a traditional approach of referral to an infectious diseases specialist or hepatologist. The secondary outcome was the proportion of infants exposed to HCV evaluated.
METHODS
An interdisciplinary team developed a program to increase evaluation and HCV treatment for postpartum individuals. Individuals who received prenatal care from March 2017 to May 2021 were eligible. Individuals with chronic HCV had a laboratory evaluation before delivery, and appropriate DAAs were selected for postpartum treatment. The health system specialty pharmacy dispensed DAA prescriptions immediately after delivery to those who were not breastfeeding. Individuals who did breastfeed had the option to begin treatment after weaning. Cure was defined as a sustained viral response or undetectable HCV RNA collected 12 weeks after completing DAA treatment.
RESULTS
We demonstrate the success of an interdisciplinary team to ensure access to therapy for the treatment of postpartum chronic HCV. Only 3 infants (25%) with mothers referred were evaluated at our institution compared with 44% of infants (n = 10) whose mothers were treated after delivery.
CONCLUSION
An interdisciplinary team for HCV treatment improves access to treatment therapy with DAAs leading to the cure of chronic HCV after delivery.
背景
慢性丙型肝炎病毒（HCV）感染在育龄人群中呈上升趋势。直接作用抗病毒药物（DAA）可治愈 HCV，但目前不建议在怀孕期间和哺乳期使用。患有 HCV 的人通常产前和产后护理不足。
目的
我们研究的目的是展示一个质量改进计划的成功，该计划旨在增加对怀孕的评估，并确保患有慢性 HCV 的人在产后期间获得 DAA 治疗药物，以在完成治疗后 12 周内实现治愈。主要结局是比较分娩后或断奶后立即接受 DAA 治疗的个体与传统转介传染病专家或肝病专家的个体的 HCV 治愈率。次要结局是评估暴露于 HCV 的婴儿比例。
方法
一个跨学科团队制定了一个增加产后个体评估和 HCV 治疗的计划。2017 年 3 月至 2021 年 5 月接受产前护理的个体符合条件。患有慢性 HCV 的个体在分娩前进行实验室评估，并为产后治疗选择适当的 DAA。产后未母乳喂养的个体可立即从医疗系统专科药房获得 DAA 处方。母乳喂养的个体可以在断奶后开始治疗。治愈定义为完成 DAA 治疗后 12 周时持续病毒学应答或检测不到 HCV RNA。
结果
我们证明了一个跨学科团队在确保为产后慢性 HCV 治疗提供治疗方面的成功。与分娩后接受治疗的母亲的 10 名婴儿（44%）相比，只有 3 名（25%）被转诊的母亲的婴儿在我们机构接受了评估。
结论
一个 HCV 治疗的跨学科团队提高了 DAA 治疗的可及性，从而在产后实现了慢性 HCV 的治愈。
Zotero 插件