Feasibility, effectiveness and cost of a decentralized HCV care model among the general population in Delhi, India.

Autor: Markby J; FIND, Geneva, Switzerland., Gupta E; The Institute of Liver and Biliary Sciences, New Delhi, India., Soni D; FIND, New Delhi, India., Sarin S; FIND, New Delhi, India., Murya M; FIND, New Delhi, India., Katapur P; FIND, New Delhi, India., Tewatia N; FIND, New Delhi, India., Ramachandran BE; FIND, New Delhi, India., Ruiz RJ 3rd; FIND, Geneva, Switzerland., Gaeddert M; Division of Infectious Disease and Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany., Tyshkovskiy A; Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia.; Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Adee M; Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Chhatwal J; Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Miglani S; Directorate General of Health Services, Government NCT of Delhi, New Delhi, India., Easterbrook P; Department of Global HIV, Hepatitis and STI Programmes Geneva, World Health Organization, Geneva, Switzerland., Sarin SK; The Institute of Liver and Biliary Sciences, New Delhi, India., Shilton S; FIND, Geneva, Switzerland.
Jazyk: angličtina
Zdroj: Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2022 Mar; Vol. 42 (3), pp. 532-540. Date of Electronic Publication: 2021 Nov 29.
DOI: 10.1111/liv.15112
Abstrakt: Background and Aims: India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale-up in testing and treatment. The "HEAD-Start Project Delhi" aimed to enhance HCV diagnosis and treatment pathways among the general population.
Methods: A prospective study was conducted at 5 district hospitals (Arm 1: one-stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment) and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn-around time were measured.
Results: Between January and September 2019, 37 425 participants were screened for HCV. The median (IQR) age of participants was 35 (26-48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P < .001). Of those confirmed positive, treatment was initiated at significantly higher rates for participants in both Arms 1 (85.6%) and 2 (73.7%) compared to Arm 3 (41.8%, P < .001). Arm 1 was found to be a cost-saving strategy compared to Arm 2, Arm 3, and no action.
Conclusions: Delivery of all services at a single site (district hospitals) resulted in a higher yield of HCV seropositive cases and retention compared with sites where participants were referred elsewhere for VL testing and/or treatment. The highest level of retention in the care cascade was also associated with the shortest turn-around times.
(© 2022 The Authors. Liver International published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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