Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia.
Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong 3220, Australia.
Viruses. 2023 Mar 31;15(4):913. doi: 10.3390/v15040913.
Hospital admissions are a missed opportunity to engage people living with hepatitis C virus (HCV) into care. This study aimed to describe the proportion of hospital inpatients and emergency department (ED) patients identified with hepatitis C who were subsequently linked to care and treatment at a metropolitan health service in Melbourne, Australia. Data were collected retrospectively from hospital databases (admissions, notifiable diseases, and pharmacy) for all adults admitted or attending the ED with separation coding indicating hepatitis C infection from March 2016 to March 2019. There were 2149 patients with at least one separation with hepatitis C coding. 15.4% (331/2149) had a documented antibody test, 4.6% (99/2149) had a documented RNA test, and 8.3% (179/2149) had a DAA prescription dispensed by hospital pharmacy. Antibody positivity was 95.2% (315/331) and RNA (when completed) was detected in 37.4% (37/99). Hepatitis specialist units had the highest rate of hepatitis C coded separations and RNA testing (39/88; 44.3%), mental health had the highest rate of antibody testing (70/276; 25.4%). Emergency had the lowest rate of antibody testing (101/1075; 13.7%) and the third highest rate of RNA testing (32/94; 34.1%), but the highest rate of RNA detected (15/32; 46.9%). This study highlights key steps to improve the care cascade. Simplified diagnostic pathways, expansion of hepatitis C care services, and clear in-hospital pathways to link patients to care would be beneficial in this setting. To scale up hepatitis C testing and treatment as part of national elimination strategies, hospital systems need to target interventions to their local data.
住院是接触丙型肝炎病毒 (HCV) 感染者并使其接受治疗的一个错失的机会。本研究旨在描述澳大利亚墨尔本一家大都市卫生服务机构中，因 HCV 感染而被住院或急诊科 (ED) 收治的住院患者和 ED 患者中，随后有多少人被转至治疗和护理。从 2016 年 3 月至 2019 年 3 月，从医院数据库（住院、传染病和药房）中回顾性收集了所有至少有一次 HCV 感染分离编码的成年住院患者和 ED 就诊患者的数据。共有 2149 例患者至少有一次 HCV 分离编码。其中 15.4%（331/2149）有记录的抗体检测，4.6%（99/2149）有记录的 RNA 检测，8.3%（179/2149）在医院药房开具了 DAA 处方。抗体阳性率为 95.2%（315/331），完成 RNA 检测的患者占 37.4%（37/99）。肝炎专科单位的 HCV 编码分离和 RNA 检测率最高（39/88；44.3%），心理健康单位的抗体检测率最高（70/276；25.4%）。急诊科的抗体检测率最低（101/1075；13.7%），但 RNA 检测率第三高（32/94；34.1%），而 RNA 检测阳性率最高（15/32；46.9%）。本研究强调了改善护理链的关键步骤。简化诊断途径、扩大丙型肝炎护理服务以及建立明确的住院患者转至护理的途径，在这种情况下将是有益的。为了作为国家消除战略的一部分扩大丙型肝炎检测和治疗，医院系统需要根据当地数据制定干预措施。
