Stratton Miranda L, Ansara Elayne D, Ifeachor Amanda P, Houck Kelly K, Liangpunsakul Suthat, Binger Katie J
Clinical Pharmacy Practitioner - Mental Health, Veteran Health Indiana, Indianapolis, Indiana.
Clinical Pharmacy Practitioner - Ambulatory Care (Gastrointestinal/Hepatitis C Virus Clinics), Veteran Health Indiana, Indianapolis, Indiana.
Ment Health Clin. 2022 Jun 10;12(3):181-186. doi: 10.9740/mhc.2022.06.181. eCollection 2022 Jun.
Hepatitis C virus (HCV) incidence rates are rising for patients with substance use and/or SUDs. Guidelines provide monitoring recommendations to ensure remission after successful treatment. The study's objective was to identify gaps in follow-up for patients with documented substance use and/or SUD through assessment of adherence to guideline-recommended HCV RNA lab 12 months post-treatment.
Patients treated for HCV through the Veteran Health Indiana Hepatitis C Pharmacy Clinic were retrospectively evaluated. Subjects were categorized based on the provider assigned for follow-up care after 12-week sustained virologic response (SVR12) labs (primary care provider [PCP] or HCV provider). The primary outcome was HCV RNA obtained 11 to 13 months post-treatment. Secondary outcomes were HCV RNA detected post-treatment, substance use, engagement in substance use treatment, and engagement with social work.
Two hundred forty-one patients were included in the HCV provider cohort and 139 in the PCP cohort. Forty-one patients did not have a specified clinic for follow-up treatment, and 20 patients did not achieve SVR12. Sixty-one patients (28%) in the HCV provider cohort completed a 12-month HCV RNA within 11 to 13 months post-treatment vs 15 patients (11%) in the PCP cohort ( ≤ .01). One patient had HCV RNA detected post-treatment.
This study reveals inadequate HCV post-treatment follow-up for patients with substance use and/or SUD. SUD is a chronic disease that requires continued monitoring to prevent complications. Further studies are needed to identify reinfection rates and improvements of care in this population.
物质使用障碍患者丙型肝炎病毒（HCV）的发病率正在上升。指南提供了监测建议，以确保成功治疗后病情缓解。本研究的目的是通过评估治疗后12个月对指南推荐的HCV RNA实验室检测的依从性，确定有记录的物质使用障碍患者在随访中的差距。
对通过印第安纳州退伍军人健康丙型肝炎药房诊所接受HCV治疗的患者进行回顾性评估。根据12周持续病毒学应答（SVR12）实验室检测后指定的随访护理提供者（初级保健提供者[PCP]或HCV提供者）对受试者进行分类。主要结局是治疗后11至13个月获得的HCV RNA。次要结局包括治疗后检测到的HCV RNA、物质使用情况、参与物质使用障碍治疗情况以及与社会工作的接触情况。
HCV提供者队列纳入了241名患者，PCP队列纳入了139名患者。41名患者没有指定的随访治疗诊所，20名患者未达到SVR12。HCV提供者队列中的61名患者（28%）在治疗后11至13个月内完成了12个月的HCV RNA检测，而PCP队列中的15名患者（11%）完成了检测（P≤0.01）。一名患者在治疗后检测到HCV RNA。
本研究揭示了物质使用障碍患者HCV治疗后随访不足的问题。物质使用障碍是一种需要持续监测以预防并发症的慢性疾病。需要进一步研究来确定该人群的再感染率以及改善护理情况。
