Brooks Ralph, Wegener Maximilian, Speers Suzanne, Nichols Lisa, Sideleau Robert, Valeriano Tequetta, Buchelli Marianne, Villanueva Merceditas
Yale University, New Haven, CT, USA.
Connecticut Department of Public Health, Hartford, CT, USA.
Health Promot Pract. 2023 Sep;24(5):1039-1049. doi: 10.1177/15248399231169792. Epub 2023 Jul 13.
Highly effective direct-acting antiviral (DAA) treatments for hepatitis C have led to strategic goals promoting hepatitis C virus (HCV) cure particularly in focus populations including persons with HIV/HCV coinfection. Implementing treatment more broadly requires both clinic-level and public health approaches such as those inherent in Data to Care (D2C) originally developed to improve the treatment cascade for persons with HIV (PWH). We used D2C methods to characterize and improve HCV treatment for persons with HIV/HCV coinfection among 11 HIV clinics in Connecticut cities with high PWH prevalence. Providers who were local champions in HCV treatment were recruited to participate along with clinic data staff and were key to quality improvement via practice transformation. We developed a methodology whereby clinic-generated lists of PWH receiving care from 2009 to 2018 were matched by CT Department of Public Health (DPH) against the state-wide HCV surveillance system. The resultant coinfection list was reviewed by clinical staff who designated HCV treatment status, enabling creation of individual clinic-level HCV treatment cascades. Data from DPH, especially current residency and deaths, enabled better characterization and allowed for refinement of longitudinal cascades. There were 1,496 patients with HIV/HCV coinfection. Sustained virologic response (SVR) rates varied by clinic (range, 44%-100%) with an aggregate SVR rate of 71% in September 2020. SVR rates improved during the project through a combination of increased treatment initiation/completion as well as data clean-up including serial updates of patient treatment status. Lack of treatment initiation was associated with being female (odds ratio [OR] = 2.18) and not having HIV viral suppression (OR = 3.24).
针对丙型肝炎的高效直接抗病毒（DAA）疗法已推动了战略目标的实现，尤其在包括艾滋病毒/丙型肝炎病毒合并感染患者在内的重点人群中促进了丙型肝炎病毒（HCV）的治愈。更广泛地实施治疗需要临床层面和公共卫生层面的方法，例如最初为改善艾滋病毒感染者（PWH）的治疗流程而开发的“以数据促关怀”（D2C）中所包含的方法。我们运用D2C方法，对康涅狄格州艾滋病毒感染者患病率较高的城市中11家艾滋病毒诊所里的艾滋病毒/丙型肝炎病毒合并感染患者的丙型肝炎治疗情况进行了特征描述并加以改善。招募了在丙型肝炎治疗方面起带头作用的当地医疗服务提供者，与诊所数据工作人员一起参与，他们是通过实践转变实现质量改进的关键。我们开发了一种方法，将2009年至2018年诊所生成的接受治疗的艾滋病毒感染者名单，由康涅狄格州公共卫生部（DPH）与全州范围的丙型肝炎监测系统进行匹配。临床工作人员对由此产生的合并感染名单进行审查，确定丙型肝炎治疗状态，从而能够创建各个诊所层面的丙型肝炎治疗流程。来自DPH的数据，尤其是当前居住情况和死亡数据，有助于更好地进行特征描述，并对纵向治疗流程进行完善。共有1496名艾滋病毒/丙型肝炎病毒合并感染患者。持续病毒学应答（SVR）率因诊所而异（范围为44% - 100%），2020年9月的总体SVR率为71%。在项目期间，通过增加治疗启动/完成率以及数据清理（包括患者治疗状态的系列更新），SVR率得到了提高。未开始治疗与女性（优势比[OR] = 2.18）以及未实现艾滋病毒病毒抑制（OR = 3.24）有关。
