Based on WHO targets, care model improves hepatitis C management in dialysis facilities
A collaborative approach between nephrologists and gastroenterologists led to improvements in the diagnosis and treatment of hepatitis C virus across 31 dialysis facilities in Changhua County, Taiwan.
The increases in diagnosis and treatment rates near the levels established by the WHO, according to Tsung-Hui Hu, MD, PhD, of Kaohsiung Chang Gung Memorial Hospital, and colleagues.
“This study demonstrates how to provide a novel county-wide treatment-delivery collaborative care model for treating [hepatitis C virus] HCV-infected [end-stage renal disease] ESRD patients in Taiwan. We achieved a 98.3% diagnosis rate and 89.1% treatment coverage for patients on dialysis in the whole county within a short period of time, which met the criteria of HCV micro-elimination,” Hu and colleagues wrote.
According to the researchers, the introduction of direct acting antivirals (DAAs) as a treatment for hepatitis C caused the WHO to begin developing strategies to eliminate the virus by 2030. In conjunction with this, the Taiwanese government seeks to treat 80% of patients with hepatitis C by 2025.
“Achieving HCV elimination is a great challenge because there is wide variation in the distribution pattern of cases and subpopulations,” the researchers wrote. "The micro-elimination approach, which focuses on treating smaller, targeted high-risk subpopulations, has been proposed as an effective means to tackle HCV. While several micro-elimination programs have been developed, most of them have been implemented in high-income countries where HCV preponderates among vulnerable populations. In contrast, few programs have targeted high-risk populations in health care settings although health care-associated HCV infections among such institutes are prevalent, particularly in middle- and low-income countries."
As hemodialysis facilities are “high-risk environments” for the virus, Hu and colleagues developed a care model that was delivered to a total of 3,657 patients. The approach focused on the following:
- collaboration between gastroenterologists and nephrologists;
- unrestricted access to DAAs;
- nurse-led case management;
- medical transportation; and
- mobile clinics.
“Outcome measures included quality indicators pertaining to six steps in HCV care ranging from HCV screening to complete treatment and cure from treatment with DAA,” the researchers wrote.
DAA treatment initiation rate and completion rate were 88.9% and 94%, respectively.
Results showed the collaborative care model led to a cure rate of 96%, with no occurrences of virologic failure.
Researchers also observed improved cumulative treatment ratios for patients with chronic hepatitis C virus infection: Ratios increased from 5.3% before interferon-based therapy in 2017 to 25.6% after restricted provision of DAA in 2017 to 2018. After universal access to DAA was introduced in 2019, the cumulative treatment ratio rose to 89.1%.
“Although elimination of HCV [in] ESRD cases in a single center has been reported, there is currently no published real-world data on the effectiveness of DAA treatment for HCV elimination in ESRD patients on a population level,” Hu and colleagues wrote. “As expected, most patients achieved SVR12 with acceptable tolerance to treatment. The high cure rate achieved in the present study also confirmed the feasibility and effectiveness of the ‘treatment as prevention’ strategy in high-risk groups. The key elements contributing to the success of the present program are of potential relevance to scale up treatment strategy and reach the WHO targets for eliminating HCV.”