Task-Shifting: An Approach to Decentralized Hepatitis C Treatment in Medically Underserved Areas
Task-Shifting: An Approach to Decentralized Hepatitis C Treatment in Medically Underserved Areas
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DOI：
10.1007/s10620-015-3911-6
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发表时间：
2015-12-01
影响因子：
3.1
通讯作者：
Ahmed, Aijaz
中科院分区：
文献类型：
--
作者：
Jayasekera, Channa R.;Perumpail, Ryan B.;Ahmed, Aijaz
尽管有安全有效的直接作用抗病毒药物（DAAs），但美国绝大多数慢性丙型肝炎（HCV）患者仍未得到治疗，部分原因是缺乏专科医生。目的确定基于daa的治疗在加利福尼亚医疗服务不足地区的有效性，在一个依赖于任务转移的医疗模式中，其中来访的肝病学家评估患者的治疗资格，但随后的患者处方治疗的常规随访评估被移交给兼职有执照的职业护士，在肝病学家的远程监督下。方法回顾性测定2013年12月至2014年11月期间接受索非布韦为基础的DAA方案的患者在治疗完成后12周的持续病毒学应答率（SVR-12）、不良事件和治疗停药率。结果：尽管在医疗服务不足的地区专科医生参与有限，58名患者中除2名外均完成了治疗，88%的患者在完成治疗12周后达到了无法检测到HCV RNA的治愈终点（持续病毒学反应，SVR-12）。几乎80%的肝硬化患者和85%有治疗经验的患者达到了SVR-12。结论：在医疗服务不足的地区，利用从专科医生到中级医生的任务转移，以索非布韦为基础的方案的治疗效果与这些方案在关键临床试验中取得的效果相当，也与美国三级保健中心的“现实世界”经验相当。
Background Despite the availability of safe and effective direct-acting antiviral drugs (DAAs), the vast majority of patients with chronic hepatitis C (HCV) in the USA remain untreated, in part due to lack of access to specialist providers.AimsTo determine the effectiveness of DAA-based treatment in medically underserved areas in California, in a healthcare model dependent on task-shifting-wherein a visiting hepatologist assesses patients for treatment eligibility, but subsequent routine follow-up evaluation of patients prescribed treatment is devolved to a part-time licensed vocational nurse under remote supervision of the hepatologist.Methods We retrospectively determined rates of sustained virologic response 12 weeks after treatment completion (SVR-12), adverse events, and treatment discontinuations in patients who received sofosbuvir-based DAA regimens between December 2013 and November 2014.Results Despite limited specialist provider involvement in medically underserved areas, all but two of 58 patients completed treatment, and 88 % of patients achieved the curative endpoint of undetectable HCV RNA 12 weeks after completing treatment (sustained virologic response, SVR-12). Almost 80 % of patients with cirrhosis and 85 % of patients with prior treatment experience achieved SVR-12.Conclusions Treatment effectiveness with sofosbuvir-based regimens in medically underserved areas utilizing task-shifting from a specialist to a mid-level provider is comparable to those achieved in pivotal clinical trials for these regimens, and to "real-world" experiences of tertiary care centers in the USA.