Cascade of Care for Hepatitis C Virus Infection within the US Veterans Health Administration

OBJECTIVES:

We measured the quality of HCV care using a cascade of HCV care model.

METHODS:

We estimated the number of patients diagnosed with chronic HCV, linked to HCV care, treated with HCV antivirals, and having achieved a sustained virologic response (SVR) in the electronic medical record data from the Veterans Health Administration's Corporate Data Warehouse and the HCV Clinical Case Registry in 2013.

RESULTS:

Of the estimated 233 898 patients with chronic HCV, 

• 77% (181 168) were diagnosed, 
• 69% (160 794) were linked to HCV care, 
• 17% (39 388) were treated with HCV antivirals, and 
• 7% (15 983) had achieved SVR.

CONCLUSIONS:

This Cascade of HCV Care provides a clinically relevant model to measure the quality of HCV care within a health care system and to compare HCV care across health systems.

Purchase full article at:   http://goo.gl/3RmCVj

By:  Maier MM1, Ross DB1, Chartier M1, Belperio PS1, Backus LI1.

• 1Marissa M. Maier is with the VA Portland Health Care System, Veterans Health Administration (VHA), Portland, OR, and the Office of Public Health/HIV, Hepatitis, and Public Health Pathogens Programs, VHA, Washington, DC. David B. Ross is with the VA Washington DC Health Care System, and the Office of Public Health/HIV, Hepatitis, and Public Health Pathogens Programs, VHA, Washington, DC. Maggie Chartier is with the VA San Francisco Health Care System, VHA, San Francisco, CA, and the Office of Public Health/HIV, Hepatitis, and Public Health Pathogens Programs, VHA, Washington, DC. Pamela S. Belperio is with the VA Greater Los Angeles Health Care System, VHA, Los Angeles, CA, and the Office of Public Health/Population Health, VHA, Washington, DC. Lisa I. Backus is with the VA Palo Alto Health Care System, VHA, Palo Alto, CA, and the Office of Public Health/Population Health, VHA, Washington, DC. 
• Am J Public Health. 2016 Feb;106(2):353-8. doi: 10.2105/AJPH.2015.302927. Epub 2015 Nov 12.

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The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service

Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community.

A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.

Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124 (48%) injected in the last month. Of 201 (72%) patients who had their fibrosis staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis. Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30–5.00, p = 0.006).

Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia–benefits that should be realised as direct-acting antiviral agents become available.

Below:  HCV Cascade of care in Australia

Full article at:  http://goo.gl/FW9kYs

By: 

Amanda J. Wade, Joseph S. Doyle, Margaret E. Hellard

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia

Amanda J. Wade, Margaret E. Hellard

School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia

Diana M. Macdonald, Joseph S. Doyle, Margaret E. Hellard

Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia

Alexander J. Thompson

Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia

Adam Gordon, Stuart K. Roberts

Department of Gastroenterology, The Alfred, Melbourne, Victoria, Australia

Stuart K. Roberts, Alexander J. Thompson

Department of Medicine, Monash University, Melbourne, Victoria, Australia

Joseph S. Doyle

Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia

 

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Effect of Abacavir on Sustained Virologic Response to HCV Treatment in HIV/HCV Co-Infected Patients, Cohere in Eurocoord

Contradicting results on the effect of abacavir (ABC) on hepatitis C virus (HCV) treatment responses in HIV/HCV co-infected patients have been reported. We evaluated the influence of ABC on the response to pegylated interferon (pegIFN) and ribavirin (RBV)-containing HCV treatment in HIV/HCV co-infected patients in a large European cohort collaboration, including data from different European countries.

HIV/HCV co-infected patients were included if they were aged ≥16 years, received pegIFN alfa-2a or 2b and RBV combination treatment and were enrolled in the COHERE cohort collaboration. Logistic regression was used to evaluate the impact of abacavir on achieving a sustained virologic response (SVR) to HCV treatment.

In total 1309 HIV/HCV co-infected patients who had received HCV therapy were included, of whom 490 (37 %) had achieved an SVR. No statistically significant difference was seen for patients using ABC-containing regimens compared to patients using an emtricitabine + tenofovir (FTC + TDF)-containing backbone, which was the most frequently used backbone. In the multivariate analyses, patients using a protease inhibitor (PI)-boosted regimen were less likely to achieve an SVR compared to patients using a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen (OR: 0.61, 95 % CI: 0.41–0.91). The backbone combinations zidovudine&lamivudine (AZT + 3TC) and stavudine&lamivudine (d4t + 3TC) were associated with lower SRV rates (0.45 (0.24–0.82) and 0.46 (0.22–0.96), respectively).

The results of this large European cohort study validate that SVR rates are generally not affected by ABC. Use of d4T or AZT as part of the HIV treatment regimen was associated with a lower likelihood of achieving an SVR.

Full article at: http://goo.gl/99tVkR

By: Colette Smit^*, Joop Arends, Lars Peters, Antonella d’Arminio Montforte, Francois Dabis,Robert Zangerle, George Daikos, Christina Mussini, Josep Mallolas, Stephane de Wit,Annelies Zinkernagel, Jaime Cosin, Genevieve Chene, Dorthe Raben, Jürgen Rockstroh andFor the Hepatitis C- working group for COHERE in Eurocoord

Stichting HIV Monitoring, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands

  

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