Austin Scarlett, Seemiller Kristi, Nolton Brittany, Hobart Emily, Ling Bruce, Ghobrial Jonathan, Robertson Thomas
Allegheny Health Network, Department of Medicine, 320 E North Ave, Pittsburgh, PA 15212, USA.
Highmark Health, Care Analytics, 120 Fifth Ave, Pittsburgh, PA 15222, USA.
J Community Hosp Intern Med Perspect. 2024 Nov 2;14(6):10-17. doi: 10.55729/2000-9666.1404. eCollection 2024.
Hepatitis C (HCV) can be treated in the primary care setting; however, most patients are referred to subspecialists. Marginalized populations may be refused treatment due to stigma or substance use. We aimed to treat HCV in these high-risk patients, and prevent a delay in time from diagnosis to the time of treatment and sustained virologic response (SVR), by utilizing a multidisciplinary treatment team in a primary care clinic. Outcomes assessed included achieving SVR at 3 months, time from diagnosis to treatment initiation, and liver fibrosis stage compared between cohorts with previous subspecialty referral and those treated initially from primary care. Among the 32 patients who initiated treatment, 29 (90.6%) completed the regimen and 27 (84.3%) had documented SVR. Patients treated in a primary care setting without prior referral had a significantly shorter median time from viral load testing to treatment initiation (161 days), compared to those who were previously referred (median time of 954 days). Aggregated fibrosis scores suggest those referred to subspecialists had significantly higher scores. We demonstrate successful HCV treatment in primary care achieving SVR, and a decrease in the median days between viral load and treatment initiation, with lower fibrosis scores.
丙型肝炎（HCV）可以在初级保健机构进行治疗；然而，大多数患者会被转诊至专科医生处。边缘化人群可能由于耻辱感或药物使用问题而被拒绝治疗。我们旨在通过在初级保健诊所组建多学科治疗团队，对这些高危患者进行HCV治疗，并防止从诊断到治疗及持续病毒学应答（SVR）的时间延迟。评估的结果包括3个月时实现SVR、从诊断到开始治疗的时间，以及比较先前转诊至专科的队列与最初在初级保健机构接受治疗的队列之间的肝纤维化阶段。在开始治疗的32例患者中，29例（90.6%）完成了治疗方案，27例（84.3%）有记录显示实现了SVR。与先前转诊的患者（中位时间为954天）相比，在初级保健机构未经事先转诊接受治疗的患者从病毒载量检测到开始治疗的中位时间显著缩短（161天）。汇总的纤维化评分表明，转诊至专科医生处的患者评分显著更高。我们证明了在初级保健机构成功治疗HCV可实现SVR，并缩短病毒载量与开始治疗之间的中位天数，同时降低纤维化评分。
