Published online Aug 27, 2023. doi: 10.4254/wjh.v15.i8.973
Peer-review started: May 27, 2023
First decision: June 14, 2023
Revised: June 19, 2023
Accepted: July 19, 2023
Article in press: July 19, 2023
Published online: August 27, 2023
Hepatitis C virus (HCV) is defined as a public health problem by the World Health Organization (WHO) and since then has defined targets through the HCV elimination. The HCV cascade of care highlights the progress towards these goals and essential interventions that need to be delivered along this continuum care.
To document the treatment cascade for patients with HCV infection at the Hospital Nossa Senhora da Conceição (HNSC), defining the percentage of antibody-positive patients who collected molecular biology tests (polymerase chain reaction), attended outpatient clinic assistance, underwent treatment, and achieved a virologic cure termed sustained virologic response (SVR).
With the retrospective cohort design, patients diagnosed with HCV infection in the period between January 1, 2015 and December 31, 2020 were included. Data from HCV notification forms, electronic medical records, Computerized Laboratory Environment Manager System, and Medicine Administration System (evaluation of special medications) were collected in 2022 and all information up to that period was considered. The data were analyzed with IBM SPSS version 25, and Poisson regression with robust simple variance was performed for analysis of variables in relation to each step of the cascade. Variables with P < 0.20 were included in the multivariate analysis with P < 0.05 considered significant. Pearson’s chi-square test was applied to compare the groups of patients who persisted in follow-up at the HNSC and who underwent follow-up at other locations.
Results were lower than expected by the WHO with only 49% of candidates receiving HCV treatment and only 29% achieving SVR, despite the 98% response rate to direct acting antivirals documented by follow-up examination. The city of origin and the place of follow-up were the variables associated with SVR and all other endpoints. When comparing the cascade of patients who remained assisted by the HNSC vs external patients, we observed superior data for HNSC patients in the SVR. Patients from the countryside and metropolitan region were mostly assisted at the HNSC and the specialized and continuous care provided at the HNSC was associated with superior results, although the outcomes remain far from the goals set by the WHO.
With the elaboration of the HCV cascade of care using local data, it was possible to stratify and evaluate risk factors associated with losses between each step of the cascade, to inform new strategies to guide elimination efforts in the future.
Core Tip: Hepatitis C virus (HCV) is defined as a public health problem by the World Health Organization and since then has defined targets through the HCV elimination. The present study aimed to document the treatment cascade for patients with HCV infection at a hospital in southern Brazil. With the retrospective cohort design, patients diagnosed with HCV infection between 2015 and 2020 were included to create the HCV cascade of care described as five exposure columns according to the stages of HCV care. Variables were related to each step of the cascade to identify obstacles for patients to reach the last step. With the elaboration of the HCV cascade of care using local data, it was possible to stratify and evaluate risk factors associated with losses between each step of the cascade, to inform new strategies to guide elimination efforts in the future.