Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2023; 15(8): 973-984
Published online Aug 27, 2023. doi: 10.4254/wjh.v15.i8.973
Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil
Manoela Badinelli Vaucher, Camila Ubirajara Silva, Ivana Rosângela Santos Varella, Arthur Yu-Shin Kim, Dimas Alexandre Kliemann
Manoela Badinelli Vaucher, Dimas Alexandre Kliemann, Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Manoela Badinelli Vaucher, Department of Medicine, Universidade do Vale do Taquari, Lajeado 95914-014, RS, Brazil
Camila Ubirajara Silva, Department of Application and Monitoring of Injectable Drugs, Hospital Sanatório Partenon, Porto Alegre 90650-000, RS, Brazil
Ivana Rosângela Santos Varella, Department of Epidemiology, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, Rio Grande do Sul, Brazil
Arthur Yu-Shin Kim, Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, United States
Arthur Yu-Shin Kim, Department of Medicine, Harvard Medical School, Boston, MA 02114, United States
Dimas Alexandre Kliemann, Departament of Infectious Diseases, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, Rio Grande do Sul, Brazil
Author contributions: Vaucher MB analyzed the data and wrote the manuscript; Silva CU performed the research; Varella IRS contributed to data analysis and helped perform the research; Kim AYS contributed analytic tools and reviewed the manuscript; and Kliemann DA designed the research study and reviewed the manuscript.
Institutional review board statement: The study was reviewed and approved by the Research Ethics Committee of the Hospitalar Conceição Group (Approval No. 51462421.8.0000.5530).
Informed consent statement: Informed consent was waived, subject to the patient’s commitment to confidentiality.
Conflict-of-interest statement: All the authors have no conflicts of interest to disclose.
Data sharing statement: Data can be acquired through the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Manoela Badinelli Vaucher, MD, Doctor, Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245 Centro Histórico, Porto Alegre 90050-170, Rio Grande do Sul, Brazil.
Received: May 27, 2023
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.