Hepatitis C virus: Testing rate and attrition at linkage to specialized care, Catalonia, Spain 2011‐2016

Reyes-Urueña, Juliana; Celly, Ana; Moreno-Fornés, Sergio; Majó, Xavier; Colom, Joan; Casabona, Jordi

doi:10.1111/jvh.13427

Cited by 4 publications

(5 citation statements)

References 32 publications

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“…A significant proportion of people with HCV infection are unaware of their diagnosis, and our ability to find these patients is becoming increasingly challenging. Previous work has shown that HCV testing is concentrated in areas with lower risk of infection[ 75 ], commonly settings where patients are either in recovery from previous drug use or ongoing drug use is more ‘controlled’. Testing needs to be expanded among ‘difficult to reach’ populations, especially those who may be in a more ‘chaotic’ phase of their drug use and are not in contact with addiction or other medical services.…”

Section: Hepatitis C Virusmentioning

confidence: 99%

“…An analysis of two large national laboratory databases from 2013 to 2016 found that 89.4% of patients diagnosed with chronic HCV infection did not receive a prescription for antiviral therapy[ 82 ]. In Spain, 49.8% of those with a positive anti-HCV result were not then linked into specialist care[ 75 ]. One reason for this is that care pathways have been unnecessarily complex including multiple investigations prior to treatment, which leads to patients frequently being lost to follow up and never completing treatment.…”

Section: Hepatitis C Virusmentioning

confidence: 99%

See 1 more Smart Citation

Viral hepatitis in 2021: The challenges remaining and how we should tackle them

Dunn¹,

Wetten²,

McPherson³

et al. 2022

WJG

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Viral hepatitis results in 1.4 million deaths annually. The World Health Organization (WHO) set an ambitious target to eliminate viral hepatitis by 2030, but significant challenges remain. These include inequalities in access to healthcare, reaching at risk populations and providing access to screening and effective treatment. Stigma around viral hepatitis persists and must be addressed. The WHO goal of global elimination by 2030 is a worthy aim, but remains ambitious and the coronavirus 2019 pandemic undoubtedly has set back progress. This review article will focus on hepatitis A to E, highlighting problems that have been resolved in the field over the past decade, those that remain to be resolved and suggest directions for future problem solving and research.

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Section: Hepatitis C Virusmentioning

confidence: 99%

Section: Hepatitis C Virusmentioning

confidence: 99%

Viral hepatitis in 2021: The challenges remaining and how we should tackle them

Dunn¹,

Wetten²,

McPherson³

et al. 2022

WJG

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“…A study that assessed positive anti-HCV test rate in Catalonia using data from the Information System for the Development of Research in Primary Care (SIDIAP (acronym in Catalan); the SIDIAP contains anonymised, longitudinal health data of over 5.6 million people (80% and 10.2% of the Catalan and Spanish population, respectively))8 revealed that, between 2011 and 2016, the positive anti-HCV test rate was higher among migrants of Asian origin (9.78 of 103 (95% CI 9.21 to 10.35)) and European and Northern American origin (5.64 of 103 (95% CI 5.33 to 5.96)), compared with the Spanish-born population (3.68 of 103 (95% CI 3.61 to 3.75)) 9. A previous study in Catalonia in 2008 reported that the Pakistani migrant community had the highest anti-HCV seroprevalence at 14.9% 10…”

Section: Introductionmentioning

confidence: 99%

“…Given that primary care physicians (PCPs) are likely not to prioritise migrants for viral hepatitis testing, 9 developing innovative and sustainable strategies to facilitate screening, treatment initiation and completion will improve health outcomes and must be evaluated. HepC link 11 was a pilot study designed to determine whether a community intervention that brings together HCV education, screening and simplified access to treatment in Pakistani migrants living in Catalonia was feasible and targeted a sample of Pakistani migrants in the Barcelona health area, where 85.89% of this population reside.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the HepClinktest-and-treat community strategy targeting Pakistani migrants with hepatitis C living in Catalonia (Spain) compared with the current practice of the Catalan health system: budget impact analysis

Reyes-Urueña,

Costell-González,

Egea-Cortés

et al. 2023

BMJ Open

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ObjectivesTo perform a budget impact analysis of the HepClinktest-and-treat strategy in which community health agents offer hepatitis C virus (HCV) testing, diagnosis and treatment to the Pakistani population living in Catalonia compared with the current practice of the Catalan health system (without targeted screening programmes).MethodsWe estimated the population of adult Pakistani migrants registered at the primary care centres in Catalonia by means of the Information System for the Development of Research in Primary Care (n=37 972 in 2019, Barcelona health area). This cohort was followed for a time period of 10 years after HCV diagnosis (2019–2028). The statistical significance of the differences observed in the anti-HCV positivity rate between screened and non-screened was confirmed (α=0.05). The budget impact was calculated from the perspective of the Catalan Department of Health. Sensitivity analyses included different levels of participation in HepClink: pessimistic, optimistic and maximum.ResultsThe HepClinkscenario screened a higher percentage of individuals (69.8%) compared with the current scenario of HCV care (39.7%). Viraemia was lower in the HepClinkscenario compared with the current scenario (1.7% vs 2.5%, respectively). The budget impact of the HepClinkscenario was €884 244.42 in 10 years.ConclusionsScaling up the HepClinkstrategy to the whole Catalan territory infers a high budget impact for the Department of Health and allows increasing the detection of viraemia (+17.8%) among Pakistani migrants ≥18 years. To achieve a sustainable elimination of HCV by improving screening and treatment rates, there is room for improvement at two levels. First, taking advantage of the fact that 68.08% of the Pakistani population had visited their primary care physicians to reinforce targeted screening in primary care. Second, to use HepClinkat the community level to reach individuals with reluctance to use healthcare services.

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“… 1 Although most of the patients who failed to undergo interferon-based treatment and those with current follow-ups have been successfully treated with direct-acting antivirals (DAA), 2 there is still a group of patients without follow-up who are considered to have difficult-to-eliminate HCV. 3 – 5 Reflex testing, which is 1-step testing using RNA assessment after the detection of positive HCV antibodies, has been shown to reduce the rate of suboptimal diagnosis (ie, those who tested positive for antibodies without RNA investigation) and increases the chances of a referral for treatment. 6 , 7 In addition, electronic alerts within medical records have been shown to reduce the rate of loss to follow-up.…”

Section: Introductionmentioning

confidence: 99%

Reengagement strategies for hepatitis C patients lost to follow-up: A randomized clinical trial

Morales-Arráez

Hernández-Bustabad

Castro

et al. 2023

Hepatology Communications

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Background and Aims: To achieve the World Health Organization’s goal of eliminating HCV by 2030, reengagement of lost to follow-up cases is mandatory. However, there is lack of evidence concerning the best strategy. Our study evaluated the effectiveness, efficiency, predictive factors, and costs of 2 different strategies. Methods: We identified patients positive for HCV antibodies without RNA requests from 2005 to 2018. Patients fulfilling trial criteria (NCT04153708) were randomized to (1) phone call or (2) letter of invitation to schedule an appointment, followed by switching strategy. Results: Three hundred forty-five patients among 1167 lost to follow-up were identified. An analysis of the first 270 randomized patients (72% male, 51±13 y) showed a higher contact rate in the mail than in the phone call strategy (84.5% vs. 50.3%). In the intention-to-treat analysis, no differences were found related to appointment attendance (26.5% vs. 28.5%). Regarding efficiency, 3.1 letters and 8 phone calls were needed to successfully link 1 patient (p<0.001) but dropped down to 2.3 phone calls if we only considered the first call attempt (p=0.008). Prior specialist’s evaluation and HCV testing in the predirect-acting antiviral era were the only factors associated with no showing up for the appointment. The cost per patient was €621.3 (2.5 quality-adjusted life-years) in the phone call strategy and €611.8 (2.4 quality-adjusted life-years) in the mail letter strategy. Conclusions: Reengagement of patients with HCV is feasible, and equally effective with similar costs in both strategies. The mail letter was more efficient, except when only 1 phone call was considered. Prior specialist’s evaluation and testing in the predirect-acting antiviral era were factors associated with nonattendance to the appointment.

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Hepatitis C virus: Testing rate and attrition at linkage to specialized care, Catalonia, Spain 2011‐2016

Cited by 4 publications

References 32 publications

Viral hepatitis in 2021: The challenges remaining and how we should tackle them

Viral hepatitis in 2021: The challenges remaining and how we should tackle them

Implementation of the HepClinktest-and-treat community strategy targeting Pakistani migrants with hepatitis C living in Catalonia (Spain) compared with the current practice of the Catalan health system: budget impact analysis

Reengagement strategies for hepatitis C patients lost to follow-up: A randomized clinical trial

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