'Waiting for DAAs': A retrospective chart review of patients with untreated hepatitis C in Rwanda

Autor: Tim Walker, Jules Kabahizi, Neil Gupta, Sabin Nsanzimana, Constance Mukabatsinda, Athanase Kiromera, Jennifer Ilo Van Nuil, Emmanuel Musabeyezu, Joia S. Mukherjee, Kevin Steiner, Aimable Mbituyumuremyi
Jazyk: angličtina
Rok vydání: 2018
Předmět:
RNA viruses
Liver Cirrhosis
Male
Pediatrics
Economics
Gastroenterology and hepatology
Social Sciences
lcsh:Medicine
Hepacivirus
medicine.disease_cause
Infographics
Health Services Accessibility
Hepatitis
Geographical Locations
0302 clinical medicine
Immunodeficiency Viruses
030212 general & internal medicine
Stage (cooking)
lcsh:Science
Pathology and laboratory medicine
Multidisciplinary
Hepatitis C virus
Hepatitis C
Medical microbiology
Middle Aged
Viral Load
Charts
Infectious hepatitis
Infectious Diseases
Viruses
Female
030211 gastroenterology & hepatology
Pathogens
Viral load
Research Article
Adult
Computer and Information Sciences
medicine.medical_specialty
Adolescent
Referral
Context (language use)
Viral diseases
Microbiology
Antiviral Agents
Time-to-Treatment
Young Adult
03 medical and health sciences
Health Economics
Retroviruses
medicine
Humans
Liver diseases
Aged
Retrospective Studies
Medicine and health sciences
Hepatitis B virus
Insurance
Health
Biology and life sciences
Flaviviruses
business.industry
Data Visualization
Lentivirus
lcsh:R
Organisms
Viral pathogens
Rwanda
HIV
medicine.disease
Fibrosis
Hepatitis viruses
Microbial pathogens
Surgery
Health Care
Co-Infections
People and Places
Africa
lcsh:Q
Health Expenditures
business
Health Insurance
Developmental Biology
Zdroj: BASE-Bielefeld Academic Search Engine
PLoS ONE, Vol 12, Iss 3, p e0174148 (2017)
PLoS ONE
Popis: Background Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. Methods and findings We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09–1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. Conclusions Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.
Databáze: OpenAIRE
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