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 Origination (WHO) and since then has defined targets through the HCV elimination.
The South region of Brazil is responsible for the highest detection rate of confirmed HCV infection in the country and also for the highest mortality rate, with higher rates than national data. Within this region, the city of Porto Alegre, in 2020 was the second capital with the highest HCV detection rate, and in 2021 the first, even higher than the national rate.
To define the continuity of care or treatment cascade for patients with chronic HCV infection at the Hospital Nossa Senhora da Conceição (HNSC) and to define sociodemographic variables that influence follow-up between each step of the cascade.
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 sustained virologic response (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.
This study identified that the sociodemographic characteristics of patients diagnosed with HCV infection at the HNSC are similar to regional and national data. It was also possible to stratify relevant risk factors for patients failing to proceed along the treatment cascade, thereby elucidating potential targeted strategies to improve care. According to the results of the hepatitis treatment at the HNSC, the importance of specialized care was highlighted. To make hepatitis treatment more accessible to patients in the countryside and metropolitan area, teams need to be properly trained.
We have the perspective that other places carry out their HCV cascade of care for stratification of local risk factors, thus helping to eliminate hepatitis C.