Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina.
Sección Hepatología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina.
J Viral Hepat. 2023 Jan;30(1):56-63. doi: 10.1111/jvh.13758. Epub 2022 Oct 17.
To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.
为了实现世界卫生组织消除丙型肝炎病毒 (HCV) 的目标，必须设计创新策略来诊断和治疗更多的患者。因此，我们旨在描述一种实施策略，以确定失去随访（LTFU）的 HCV 患者，并为他们重新联系 HCV 护理。我们在 13 个拉丁美洲国家开展了一项实施研究，利用一种策略来联系未定期随访的 HCV 患者。HCV 患者通过国际疾病分类（ICD-9/10）或等效方法确定。然后审查病历以确认慢性 HCV 感染的诊断，定义为抗 HCV+和可检测 HCV-RNA。确定未由肝脏专家随访的患者通过电话或电子邮件联系，并提供医疗重新评估。共分类 10364 例 HCV 患者。审查病历后，1349 例（13%）HCV-RNA 不可检测或编码错误。总体而言，9015 例（86.9%）个体被确定为慢性 HCV 感染。共有 5096 例（56.5%）患者接受常规 HCV 护理，3919 例（43.5%）失去随访。我们能够联系到 3919 例 LTFU 患者中的 1617 例（41.3%）在初级医疗机构，其中 427 例（26.4%）在不同机构治愈或死亡。在其余患者中，906 例（76.1%）是检索的候选者。在我们的队列中，大约四分之一失去随访的慢性 HCV 患者是接受治疗的候选者。这种策略具有有效性、可及性，并对 HCV 护理级联产生重大影响。
