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1.
Ann Hepatol ; 17(2): 223-231, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31097237

RESUMO

INTRODUCTION: The availability of curative hepatitis C therapies has created an opportunity to improve treatment delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. MATERIAL AND METHODS: Using a communitybased prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: (1) treatment effectiveness using intention-to-treat analysis; and (2) patient treatment experience assessed using demographics, adverse events, and medication adherence. RESULTS: During the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses. CONCLUSION: In conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.


Assuntos
Antivirais/economia , Antivirais/uso terapêutico , Serviços de Saúde Comunitária/economia , Prestação Integrada de Cuidados de Saúde/economia , Custos de Medicamentos , Acessibilidade aos Serviços de Saúde/economia , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Adulto , Idoso , Antivirais/efeitos adversos , Bases de Dados Factuais , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ilha do Príncipe Eduardo/epidemiologia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Encaminhamento e Consulta/economia , Fatores de Tempo , Tempo para o Tratamento/economia , Resultado do Tratamento , Adulto Jovem
2.
Ann Hepatol ; 16(5): 749-758, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28809740

RESUMO

INTRODUCTION: The availability of curative hepatitis C therapies has created an opportunity to improve delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. MATERIAL AND METHODS: Using a community based prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: 1) Treatment effectiveness using intention-to-treat analysis; and 2) Patient treatment experience assessed using demographics, adverse events, and medication adherence. RESULTS: During the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses. CONCLUSION: In conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.


Assuntos
Antivirais/uso terapêutico , Financiamento Governamental , Custos de Cuidados de Saúde , Hepatite C Crônica/tratamento farmacológico , Adulto , Idoso , Antivirais/efeitos adversos , Análise Custo-Benefício , Bases de Dados Factuais , Custos de Medicamentos , Feminino , Acessibilidade aos Serviços de Saúde , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Hepatite C Crônica/virologia , Humanos , Análise de Intenção de Tratamento , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Ilha do Príncipe Eduardo , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Resposta Viral Sustentada , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
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