Hepatitis C care cascade among patients with and without tuberculosis: Nationwide observational cohort study in the country of Georgia, 2015-2020.
Hepatitis C care cascade among patients with and without tuberculosis: Nationwide observational cohort study in the country of Georgia, 2015-2020.
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DOI：
10.1371/journal.pmed.1004121
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发表时间：
2023-05
期刊：
影响因子：
15.8
通讯作者：
Kempker, Russell
中科院分区：
文献类型：
--
作者：
Baliashvili, Davit;Blumberg, Henry;Gandhi, Neel;Averhoff, Francisco;Benkeser, David;Shadaker, Shaun;Gvinjilia, Lia;Turdziladze, Aleksandre;Tukvadze, Nestani;Chincharauli, Mamuka;Butsashvili, Maia R.;Sharvadze, Lali;Tsertsvadze, Tengiz;Zarkua, Jaba;Kempker, Russell
东欧国家格鲁吉亚于2015年启动了一项全国性的丙型肝炎病毒（HCV）消除计划，以解决高感染负担。通过抗体检测筛查HCV感染已纳入多个现有计划，包括国家结核病计划（NTP）。我们试图比较2015年至2019年期间格鲁吉亚有和无结核病（TB）诊断的患者之间的丙型肝炎护理级联，并确定与TB患者丙型肝炎护理失访（LTFU）相关的因素。使用国家ID号，我们合并了2015年1月1日至2020年9月30日期间HCV消除计划，NTP和国家死亡登记处的数据库。研究人群包括2015年1月1日至2019年12月31日期间诊断为活动性结核病的11，985名成人（年龄≥18岁），以及2015年1月1日至2020年9月30日期间检测HCV抗体的1，849，820名成人，他们在此期间未被诊断为结核病。我们估计了在HCV治疗级联的每个步骤中LTFU的TB患者和非TB患者的比例，并探索了时间变化。在11，985名活动性结核病患者中，9，065名（76%）既往未接受丙型肝炎治疗的患者进行了HCV抗体检测，其中1，665名（18%）结果呈阳性;丙型肝炎护理中的LTFU很常见，1,557例抗体检测阳性的患者中有316例（20%）没有接受病毒血症检测，025例（43%）病毒血症患者未开始丙型肝炎治疗。总体而言，在确诊病毒血症HCV感染的患者中，由于在护理级联的各个阶段的LTFU，只有28%的TB患者有记录证明HCV感染治愈，而非TB患者的这一比例为55%。在过去3年中，抗体检测阳性后的LTFU大幅下降，从2017年诊断为结核病的患者中的32%下降到2019年诊断为结核病的患者中的12%。在HCV抗体检测阳性后，非结核病患者比结核病患者更早进行病毒血症检测（风险比[HR] = 1.46，95%置信区间[CI] [1.39，1.54]，p < 0.001）。在病毒血症检测阳性后，非结核病患者比结核病患者更早开始丙型肝炎治疗（HR = 2.05，95% CI [1.87，2.25]，p < 0.001）。在校正了年龄、性别和病例定义（新与既往治疗）的风险因素分析中，多重耐药（MDR）TB与HCV抗体检测阳性后LTFU风险增加相关（校正风险比[aRR] = 1.41，95% CI [1.12，1.76]，p = 0.003）。本研究的主要局限性是，由于依赖于现有的电子数据库，我们无法解释部分分析中所有混杂因素的影响。在抗体或病毒血症检测阳性后，丙型肝炎护理的LTFU在结核病患者中比非结核病患者更高，更常见。更好地整合结核病和丙型肝炎护理系统可以潜在地减少LTFU并改善格鲁吉亚和其他正在启动或扩大其全国丙型肝炎控制工作并努力提供个性化结核病治疗的国家的患者结局。在一项来自格鲁吉亚的观察性队列研究中，Davit Baliashvili及其同事探讨了结核病患者是否接受了完整和及时的丙型肝炎治疗。有充分的证据表明，丙型肝炎的患病率在结核病（TB）患者中非常高。丙型肝炎的高效新治疗方案使包括格鲁吉亚在内的许多国家能够实施大规模的丙型肝炎计划。目前还没有很好地描述目前或过去患有结核病的患者多久被提供和提供丙型肝炎检测和治疗服务。我们进行了一项观察性队列研究，比较了结核病患者和非结核病患者的丙型肝炎护理级联，以探讨结核病患者是否完全及时地接受丙型肝炎治疗。接受丙型肝炎病毒（HCV）抗体检测的结核病患者比例每年都在增加。在2015年诊断为结核病的患者中，60%的人在研究期间的某个时候接受了HCV抗体检测。在2019年诊断为结核病的患者中，这一比例达到90%，丙型肝炎护理的失访（LTFU）在结核病患者中更为常见，20%的抗体检测阳性患者未接受病毒血症检测，43%的病毒血症患者未开始治疗丙型肝炎。相比之下，非结核病患者的人数分别为14%和19%。我们的研究结果强调了在结核病患者中改善丙型肝炎诊断和治疗服务的整合和联系的重要性。格鲁吉亚和其他国家现有的结核病和丙型肝炎大规模公共卫生计划为这两种传染病的综合护理创造了独特的机会，这可能会减少LTFU并改善整体健康结果。
The Eastern European country of Georgia initiated a nationwide hepatitis C virus (HCV) elimination program in 2015 to address a high burden of infection. Screening for HCV infection through antibody testing was integrated into multiple existing programs, including the National Tuberculosis Program (NTP). We sought to compare the hepatitis C care cascade among patients with and without tuberculosis (TB) diagnosis in Georgia between 2015 and 2019 and to identify factors associated with loss to follow-up (LTFU) in hepatitis C care among patients with TB. Using national ID numbers, we merged databases of the HCV elimination program, NTP, and national death registry from January 1, 2015 to September 30, 2020. The study population included 11,985 adults (aged ≥18 years) diagnosed with active TB from January 1, 2015 through December 31, 2019, and 1,849,820 adults tested for HCV antibodies between January 1, 2015 and September 30, 2020, who were not diagnosed with TB during that time. We estimated the proportion of patients with and without TB who were LTFU at each step of the HCV care cascade and explored temporal changes. Among 11,985 patients with active TB, 9,065 (76%) patients without prior hepatitis C treatment were tested for HCV antibodies, of which 1,665 (18%) had a positive result; LTFU from hepatitis C care was common, with 316 of 1,557 (20%) patients with a positive antibody test not undergoing viremia testing and 443 of 1,025 (43%) patients with viremia not starting treatment for hepatitis C. Overall, among persons with confirmed viremic HCV infection, due to LTFU at various stages of the care cascade only 28% of patients with TB had a documented cure from HCV infection, compared to 55% among patients without TB. LTFU after positive antibody testing substantially decreased in the last 3 years, from 32% among patients diagnosed with TB in 2017 to 12% among those diagnosed in 2019. After a positive HCV antibody test, patients without TB had viremia testing sooner than patients with TB (hazards ratio [HR] = 1.46, 95% confidence intervals [CI] [1.39, 1.54], p < 0.001). After a positive viremia test, patients without TB started hepatitis C treatment sooner than patients with TB (HR = 2.05, 95% CI [1.87, 2.25], p < 0.001). In the risk factor analysis adjusted for age, sex, and case definition (new versus previously treated), multidrug-resistant (MDR) TB was associated with an increased risk of LTFU after a positive HCV antibody test (adjusted risk ratio [aRR] = 1.41, 95% CI [1.12, 1.76], p = 0.003). The main limitation of this study was that due to the reliance on existing electronic databases, we were unable to account for the impact of all confounding factors in some of the analyses. LTFU from hepatitis C care after a positive antibody or viremia test was high and more common among patients with TB than in those without TB. Better integration of TB and hepatitis C care systems can potentially reduce LTFU and improve patient outcomes both in Georgia and other countries that are initiating or scaling up their nationwide hepatitis C control efforts and striving to provide personalized TB treatment. In an observational cohort study from Georgia, Davit Baliashvili and colleagues explore whether patients with tuberculosis receive complete and timely treatment for hepatitis C. There is ample evidence that hepatitis C prevalence is disproportionally high among patients with tuberculosis (TB). Highly effective new treatment options for hepatitis C allowed many countries, including Georgia, to implement large-scale hepatitis C programs. It has not been well characterized how often patients with current or past TB are offered and provided with hepatitis C testing and treatment services. We conducted an observational cohort study comparing the hepatitis C care cascade among patients with and without TB to explore if patients with tuberculosis receive hepatitis C treatment completely and timely. The proportion of patients with TB tested for hepatitis C virus (HCV) antibodies increased per year. Among patients diagnosed with TB in 2015, 60% were tested for HCV antibodies sometime during the study period. This proportion reached 90% among patients diagnosed with TB in 2019 Loss to follow-up (LTFU) from hepatitis C care was more common among patients with TB, with 20% of patients with a positive antibody test not undergoing viremia testing and 43% of patients with viremia not starting treatment for hepatitis C. For comparison, the respective numbers among patients without TB were 14% and 19%. Our findings highlight the importance of improving integration and linkage to hepatitis C diagnostic and treatment services among patients with TB. Existing large-scale public health programs for both TB and hepatitis C in Georgia and other countries with nationwide programs create a unique opportunity for integrated care of these 2 infectious diseases, which could potentially reduce LTFU and improve overall health outcomes.
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影响因子：
76.2
作者：
Lan, Zhiyi;Ahmad, Nafees;Menzies, Dick
通讯作者：
Menzies, Dick
DOI：
10.1016/j.drugpo.2020.102893
发表时间：
2020-10
期刊：
The International journal on drug policy
影响因子：
--
作者：
Butsashvili M;Kamkamidze G;Kajaia M;Gvinjilia L;Kuchuloria T;Khonelidze I;Gogia M;Dolmazashvili E;Kerashvili V;Zakalashvili M;Shadaker S;Nasrullah M;Sonjelle S;Japaridze M;Averhoff F
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影响因子：
5.1
作者：
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通讯作者：
Gretch, D R
影响因子：
11.8
作者：
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Feld, Jordan J.
影响因子：
56.3
作者：
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通讯作者：
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