Year 2021 / Volume 113 / Number 12
Original
Chronic hepatitis C patients lost in the system: predictive factors of non-referral or loss of follow-up in Hepatology units

833-839

DOI: 10.17235/reed.2020.7573/2020

Pilar del Pino Bellido, María Fernanda Guerra Veloz, Patricia Cordero Ruiz, Francisco Bellido Muñoz, Francisco Vega Rodríguez, Ángel Caunedo Álvarez, Isabel Carmona Soria,

Abstract
Introduction: several barriers remain in the hepatitis C care cascade, which need to be removed in order to eliminate chronic hepatitis C. These barriers include deficiencies in screening and confirmatory diagnosis as well as difficulties in accessing treatment. Aims: to identify factors associated with the non-referral of patients with positive hepatitis C virus (HCV) antibodies and to identify factors associated with loss of follow-up or non-attendance of these patients to specialist consultation after referral. Methods: observational and retrospective single-center-study, including all positive HCV serology tests performed between January 2013 and May 2018, in the Virgen Macarena health area (Seville, Spain) before implementing the one-step diagnosis. Non-referred patients and patients who were lost to follow-up after being referred were identified. Results: a total of 54 (77.4 %) patients diagnosed in Primary Care (PC) and 54 (22.2 %) from hospital specialists were not referred (p < 0.001). Predictors for non-referral were: stay in prison/institutionalization (p = 0.04), suffering chronic obstructive pulmonary disease (COPD) (p = 0.07), a normal AST value (p = 0.034) or test requested by Primary Care physician (PCP) (p = 0.004). Patients referred from PC were more likely to be lost to follow-up than those referred from hospital specialists (p < 0.001). Predictors of follow-up loss included: opioid replacement therapy (p = 0.034), absence of high blood pressure (p = 0.039) and test requested by PCP (p = 0.049). Conclusions: a high percentage of patients with positive HCV serology were not referred or were lost to follow-up, mainly those belonging to high risk social groups or those with associated comorbidities. Patients with average values of transaminases or those diagnosed in PC were also less frequently referred.
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References
1. Acero Fernández D, Ferri Iglesias MJ, Buxó Pujolràs M, López Nuñez C, Serra Matamala I, Queralt Molés X, et al. Changes in the epidemiology and distribution of the hepatitis C virus genotypes in North-Eastern Spain over the last 35 years. Gastroenterol Hepatol. 2018;41(1):2–11.
2. Crespo J, Albillos A, Buti M, Calleja JL, García Samaniego J, Hernández Guerra M, et al. Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH). Rev Esp Enferm Dig. 2019;111(11):862–73.
3. Bailey JR, Barnes E, Cox AL. Approaches, Progress, and Challenges to Hepatitis C Vaccine Development. Gastroenterology [Internet]. 2019;156(2):418–30. Available from: https://doi.org/10.1053/j.gastro.2018.08.060
4. Baumert TF, Berg T LJND. Status of Direct-acting Antiviral Therapy for HCV Infection and Remaining Challenges. Gastroenterology. 2019;156(2):431–45.
5. Spearman CW, Dusheiko GM, Hellard M, Sonderup M. Hepatitis C. Lancet. 2019;394(10207):1451–66.
6. Ioannou GN, Feld JJ. What Are the Benefits of a Sustained Virologic Response to Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection? Gastroenterology [Internet]. 2019;156(2):446-460.e2. Available from: https://doi.org/10.1053/j.gastro.2018.10.033
7. Konerman MA, Lok ASF. Hepatitis C treatment and barriers to eradication. Clin Transl Gastroenterol. 2016;7(9):1–6.
8. Buonomo AR, Scotto R, Pinchera B, Coppola N, Monari C, Macera M, et al. Epidemiology and risk factors for hepatitis C virus genotypes in a high prevalence region in Italy. New Microbiol. 2018;41(1):26–9.
9. Simpson H, Manley P, Lawler J, Morey S, Buchanan E, Hewett M, et al. Distance to treatment as a factor for loss to follow up of hepatitis C patients in North East England. J Public Health (Oxf). 2019 Dec;41(4):700–6.
10. Botterman R, Verhelst X, Buffel V, Derese A, Van Der Paelt T, De Volder G, et al. Hepatitis C in two general practices in Flanders, Belgium: is there a need to reconsider current screening recommendations? Acta Clin Belg. 2020 May;1–8.
11. Barror S, Avramovic G, Oprea C, Surey J, Story A, Macías J, et al. HepCare Europe: a service innovation project. HepCheck: enhancing HCV identification and linkage to care for vulnerable populations through intensified outreach screening. A prospective multisite feasibility study. J Antimicrob Chemother. 2019 Nov;74(Suppl 5):v39–46.
12. Wait S, Kell E, Hamid S, Muljono DH, Sollano J, Mohamed R, et al. Hepatitis B and hepatitis C in southeast and southern Asia: challenges for governments. lancet Gastroenterol Hepatol. 2016 Nov;1(3):248–55.
13. Calner P, Sperring H, Ruiz-Mercado G, Miller NS, Andry C, Battisti L, et al. HCV screening, linkage to care, and treatment patterns at different sites across one academic medical center. PLoS One. 2019;14(7):1–11.
14. Calleja JL, Lens S, Fernández M CJ. Definition of the profiles of hepatitis C virus patients based on the identification of risky practices in Spain. Rev Esp Enferm Dig. 2019 Sep 17;111(10):731–7.
15. Crespo J, Grupo técnico de cribado de la infección por el VHC. Screening guide for HCV infection in Spain. Rev Esp Enferm Dig (en prensa).
16. Flisiak R, Frankova S, Grgurevic I, Hunyady B, Jarcuska P, Kupčinskas L, et al. How close are we to hepatitis C virus elimination in Central Europe? Clin Exp Hepatol [Internet]. 2020/02/17. 2020 Feb;6(1):1–8. Available from: https://pubmed.ncbi.nlm.nih.gov/32166117
17. Aleman S, Söderholm J, Büsch K, Kövamees J, Duberg AS. Frequent loss to follow-up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus. Liver Int. 2020;40(8):1832–40.
18. Andaluz I, Arcos M del M, Montero MD, Castillo P, Martín-Carbonero L, García-Samaniego J, et al. Patients with hepatitis C lost to follow-up: Ethical-legal aspects and search results. Rev Esp Enferm Dig. 2020;112(7):532–7.
19. Mravčík V, Strada L, Štolfa J, Bencko V, Groshkova T, Reimer J, et al. Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: A literature review. Patient Prefer Adherence. 2013;7:1067–75.
20. Morales-Arraez D, Alonso-Larruga A, Diaz-Flores F, García Dopico JA, de Vera A, Quintero E, et al. Predictive factors for not undergoing RNA testing in patients found to have hepatitis C serology and impact of an automatic alert. J Viral Hepat. 2019;26(9):1117–23.
21. Falade-Nwulia O, Mehta SH, Lasola J, Latkin C, Niculescu A, O’Connor C, et al. Public health clinic-based hepatitis C testing and linkage to care in Baltimore. J Viral Hepat [Internet]. 2016/02/03. 2016 May;23(5):366–74. Available from: https://pubmed.ncbi.nlm.nih.gov/26840570
22. Grebely J, Bryant J, Hull P, Hopwood M, Lavis Y, Dore GJ, et al. Factors associated with specialist assessment and treatment for hepatitis C virus infection in New South Wales, Australia. J Viral Hepat. 2011;18(4):104–16.
23. Crowley D, Murtagh R, Cullen W, Lambert JS, McHugh T, Van Hout MC. Hepatitis C virus infection in Irish drug users and prisoners - A scoping review. BMC Infect Dis. 2019;19(1):1–27.
24. Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet (London, England) [Internet]. 2017/11/12. 2018 Jan 20;391(10117):241–50. Available from: https://pubmed.ncbi.nlm.nih.gov/29137869
25. Connoley D, Francis-Graham S, Storer M, Ekeke N, Smith C, Macdonald D, et al. Detection, stratification and treatment of hepatitis C-positive prisoners in the United Kingdom prison estate: Development of a pathway of care to facilitate the elimination of hepatitis C in a London prison. J Viral Hepat. 2020 May;
26. Eminler AT, Ayyildiz T, Irak K, Kiyici M, Gurel S, Dolar E, et al. AST/ALT ratio is not useful in predicting the degree of fibrosis in chronic viral hepatitis patients. Eur J Gastroenterol Hepatol [Internet]. 2015;27(12):1361–6. Available from: http://europepmc.org/abstract/MED/26352130
27. Horwood J, Clement C, Roberts K, Waldron C-A, Irving WL, Macleod J, et al. Increasing uptake of hepatitis C virus infection case-finding, testing, and treatment in primary care: evaluation of the HepCATT (Hepatitis C Assessment Through to Treatment) trial. Br J Gen Pract J R Coll Gen Pract. 2020 Aug;70(697):e581–8.
28. Turner BJ, Rochat A, Lill S, Bobadilla R, Hernandez L, Choi A, et al. Hepatitis C Virus Screening and Care: Complexity of Implementation in Primary Care Practices Serving Disadvantaged Populations. Ann Intern Med [Internet]. 2019 Dec 3;171(12):865–74. Available from: https://www.acpjournals.org/doi/abs/10.7326/M18-3573
29. Samuel ST, Martinez AD, Chen Y, Markatou M, Talal AH. Hepatitis C virus knowledge improves hepatitis C virus screening practices among primary care physicians. World J Hepatol. 2018;10(2):319–28.
30. Kattakuzhy S, Gross C, Emmanuel B, Teferi G, Jenkins V, Silk R, et al. Expansion of Treatment for Hepatitis C Virus Infection by Task Shifting to Community-Based Nonspecialist Providers: A Nonrandomized Clinical Trial. Ann Intern Med. 2017 Sep;167(5):311–8.
31. Crowley D, Cullen W, Laird E, Lambert JS, Mc Hugh T, Murphy C, et al. Exploring patient characteristics and barriers to Hepatitis C treatment in patients on opioid substitution treatment attending a community based fibro-scanning clinic. J Transl Intern Med. 2017;5(2):112–9.
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del Pino Bellido P, Guerra Veloz M, Cordero Ruiz P, Bellido Muñoz F, Vega Rodríguez F, Caunedo Álvarez Á, et all. Chronic hepatitis C patients lost in the system: predictive factors of non-referral or loss of follow-up in Hepatology units . 7573/2020


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Publication history

Received: 07/10/2020

Accepted: 25/11/2020

Online First: 04/01/2021

Published: 09/12/2021

Article revision time: 36 days

Article Online First time: 89 days

Article editing time: 428 days


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