Sorafenib for Treatment of Hepatocellular Carcinoma: A Survival Analysis From the South American Liver Research Network.

GOALS: We aim to describe the efficacy, safety profile, and variables associated with survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib in South America. BACKGROUND: Sorafenib has been shown to improve survival in patients with advanced HCC. There are few data on sorafenib use for HCC in South America. STUDY: We performed a retrospective analysis of HCC cases treated with sorafenib from 8 medical centers in 5 South American countries, between January 2010 and June 2017. The primary endpoint was overall survival (OS), which was defined as time from sorafenib initiation to death or last follow-up. Risk factors for decreased OS were assessed using Cox proportional hazard regression and log-rank tests. RESULTS: Of 1336 evaluated patients, 127 were treated with sorafenib and were included in the study. The median age of individuals was 65 years (interquartile range, 55 to 71) and 70% were male individuals. Median OS in all patients was 8 months (interquartile range, 2 to 17). Variables associated with survival on multivariate analysis were platelets >/<250,000 mm (2 vs. 8 mo, P=0.01) and Barcelona Clinic Liver Cancer (BCLC) stage (A/B, 13 vs. C/D, 6 mo; P=0.04). In a subanalysis of patients with BCLC stage C, platelets >/<250,000 mm were also independently associated with survival (2 vs. 5.5 mo, P=0.03). Patients lived longer if they experienced any side effects from sorafenib use (11 vs. 2 mo, P=0.009). Patients who stopped sorafenib because of side effects had shorter survival compared with patients who were able to tolerate side effects and continue treatment (7.5 vs. 13 mo, P=0.01). CONCLUSIONS: Pretreatment elevation of platelets and advanced BCLC stage were independently associated with poor survival on sorafenib in a South American cohort.

Interprofessional education between medical students and nurse practitioner students in a Global Health course.

BACKGROUND: Few global health experiences include intentionally-directed interprofessional training. We aim to prospectively evaluate the impact of a global health elective in facilitating interprofessional education (IPE) and promoting cultural sensitivity. METHODS: We included in our study, medical and nursing students who participated in the 2015 and 2016 cohorts of the Nicaragua Global Health course. The course consisted of a 12-week curriculum, and included an in-country immersion where students were organized into small-groups that participated in a variety of interprofessional activities. Students filled out pre- and post-course surveys. We performed quantitative analysis on numeric data and qualitative analysis on open-ended questions. RESULTS: Of 39 total students enrolled in the course, 26 (18 medical and 8 nursing students) participated in the study and filled out the pre- and post-course surveys. Mean competency scores increased for all questions between pre- and post-course surveys, and of these, 5 of 7 reached statistical significance. Qualitative themes identified included: 1) the importance of understanding other team member's roles and relative strengths; 2) the value provided by the breaking down of traditional power dynamics between clinicians. CONCLUSIONS: Global health experiences represent a unique and under-utilized opportunity for facilitating IPE.

Validation of a point-of-care rapid diagnostic test for hepatitis C for use in resource-limited settings.

BACKGROUND: Treatment of HCV with direct-acting antivirals has enabled the discussion of HCV eradication worldwide. Envisioning this aim requires implementation of mass screening in resource-limited areas, usually constrained by testing costs. METHODS: We validated a low-cost, rapid diagnosis test (RDT) for HCV in three different continents in 141 individuals. RESULTS: The HCV RDT showed 100% specificity and sensitivity across different samples regardless of genotype or viral load (in samples with such information, 90%). CONCLUSIONS: The HCV test validated in this study can allow for HCV screening in areas of need when properly used.

Evaluation of Rapid Diagnostic Tests for Assessment of Hepatitis B in Resource-Limited Settings.

Chronic Hepatitis B (HBV) is the most important cause of liver disease worldwide. There is a need for low-cost tests to aid in diagnosis and management of HBV infection in resource-limited settings. We evaluated the utility of several rapid diagnostic tests (RDT) in three different continents (Europe, South America, Africa). The HBsAg RDT showed optimal sensitivity and specificity. The anti-HBeAb RDT showed acceptable sensitivity and excellent specificity. Our results suggest that these RDTs could be used for screening and management of HBV.