Feasibility, effectiveness and cost of a decentralized HCV care model among the general population in Delhi, India.
Feasibility, effectiveness and cost of a decentralized HCV care model among the general population in Delhi, India.
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DOI：
10.1111/liv.15112
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发表时间：
2022-03
影响因子：
6.7
通讯作者：
Shilton, Sonjelle
中科院分区：
文献类型：
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作者：
Markby, Jessica;Gupta, Ekta;Soni, Divya;Sarin, Sanjay;Murya, Mugil;Katapur, Preetishirin;Tewatia, Navneet;Ramachandran, Babu Entoor;Ruiz, Ryan Jose;Gaeddert, Mary;Tyshkovskiy, Alexander;Adee, Madeline;Chhatwal, Jagpreet;Miglani, Sundeep;Easterbrook, Philippa;Sarin, Shiv K.;Shilton, Sonjelle
印度有很大的丙型肝炎病毒感染负担，并承诺到2030年实现全国消灭丙型肝炎病毒。这将需要在检测和治疗方面大幅扩大规模。“新德里先行计划”旨在加强普通人群中丙型肝炎的诊断和治疗途径。在5家地区医院(第1组：一站式商店)、15家综合诊所(第2组：病毒载量检测和治疗转诊)和62个筛查营地(第3组：转诊治疗)进行了前瞻性研究。测量了丙型肝炎病毒流行率、在丙型肝炎病毒护理级联中的滞留率和转归时间。在2019年1月至9月期间，37,425名参与者接受了丙型肝炎病毒筛查。参与者的智商(IQR)中位数为35岁(26-48岁)，其中50.4%为男性，49.6%为女性。第1组(93.7%)和第3组(90.3%)的受试者接受VL测试的比例明显高于第2组(52.5%，P<；等.001)。在确认阳性的患者中，第1组(85.6%)和第2组(73.7%)的患者开始接受治疗的比率明显高于第3组(41.8%，P<；10.001)。与ARM 2、ARM 3相比，ARM 1被发现是一种节省成本的策略，并且不采取行动。与参与者被转介到其他地方进行VL检测和/或治疗的地点相比，在一个地点(地区医院)提供所有服务导致了更高的丙型肝炎血清阳性病例和滞留率。护理级联中最高水平的保留率也与最短的周转时间有关。
India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale‐up in testing and treatment. The “HEAD‐Start Project Delhi” aimed to enhance HCV diagnosis and treatment pathways among the general population. A prospective study was conducted at 5 district hospitals (Arm 1: one‐stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment) and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn‐around time were measured. Between January and September 2019, 37 425 participants were screened for HCV. The median (IQR) age of participants was 35 (26‐48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P < .001). Of those confirmed positive, treatment was initiated at significantly higher rates for participants in both Arms 1 (85.6%) and 2 (73.7%) compared to Arm 3 (41.8%, P < .001). Arm 1 was found to be a cost‐saving strategy compared to Arm 2, Arm 3, and no action. Delivery of all services at a single site (district hospitals) resulted in a higher yield of HCV seropositive cases and retention compared with sites where participants were referred elsewhere for VL testing and/or treatment. The highest level of retention in the care cascade was also associated with the shortest turn‐around times.
DOI：
10.1016/s2214-109x(20)30505-2
发表时间：
2021-04
期刊：
The Lancet. Global health
影响因子：
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作者：
Oru E;Trickey A;Shirali R;Kanters S;Easterbrook P
通讯作者：
Easterbrook P
影响因子：
2.5
作者：
Iwamoto M;Calzia A;Dublineau A;Rouet F;Nouhin J;Yann S;Pin S;Sun C;Sann K;Dimanche C;Lastrucci C;Coulborn RM;Maman D;Dousset JP;Loarec A
通讯作者：
Loarec A
影响因子：
39.2
作者：
Chhatwal J;Kanwal F;Roberts MS;Dunn MA
通讯作者：
Dunn MA