O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZIL
Introduction and Objectives: Hepatitis C virus (HCV) eradication from dialysis facilities in a community using direct acting antivirals (DAAs) may be achieved more effectively under a collaborative care model, including a network of hepatologists, nephrologists and specialized dialysis staff. This s...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268123001333 |
| _version_ | 1797862174056513536 |
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| author | Hugo Cheinquer Alexandre de Araujo Dirceu da Silva Reis |
| author_facet | Hugo Cheinquer Alexandre de Araujo Dirceu da Silva Reis |
| author_sort | Hugo Cheinquer |
| collection | DOAJ |
| description | Introduction and Objectives: Hepatitis C virus (HCV) eradication from dialysis facilities in a community using direct acting antivirals (DAAs) may be achieved more effectively under a collaborative care model, including a network of hepatologists, nephrologists and specialized dialysis staff. This study aimed to evaluate the prevalence of HCV infection in patients undergoing renal replacement therapy in all registered dialysis units operating in Rio Grande do Sul State (RS), in Southern Brazil. Furthermore, to implement a strategy to treat HCV infection locally at these units. Materials and Methods: All dialysis units in RS State were contacted between January 2020 and January 2022 to provide results of anti-HCV screening in dialysis patients. Those with positive results were discussed via telemedicine with a team of two hepatologists and one nephrologist located in Clinics Hospital of Porto Alegre, a tertiary health care facility. Dialysis staff was instructed to test HCV RNA with polymerase chain reaction (PCR) and calculate FIB-4 and APRI scores. Viremic patients were selected for therapy and those with FIB-4 >3.25 and/or APRI >1.5 were required to undergo ultrasonography and/or elastography. DAA therapy was started locally by the dialysis unit staff under the supervision of the hepatologists. Results: A total of 6,991 patients from all 66 dialysis facilities in RS State were enrolled. Most patients (93.3%) were on hemodialysis. All patients completed HCV screening and 454 (6.5%) were anti-HCV positive. So far, nine units have completed the proposed model, with 89 anti-HCV positive patients that resulted in 49 (55.5%) with detectable HCV RNA by PCR. All viremic patients started HCV therapy. Interim analysis showed SVR in 21 (95.5%) of 22 patients. Conclusions: A collaborative care model increased the rates of diagnosis and treatment for HCV in dialysis facilities to levels near those established by the World Health Organization towards HCV elimination up to 2030. |
| first_indexed | 2024-04-09T22:14:57Z |
| format | Article |
| id | doaj.art-4a9fc53a1d664dfd8000014dd0966c4b |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-04-09T22:14:57Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-4a9fc53a1d664dfd8000014dd0966c4b2023-03-23T04:34:37ZengElsevierAnnals of Hepatology1665-26812023-03-0128101029O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZILHugo Cheinquer0Alexandre de Araujo1Dirceu da Silva Reis2Clinics Hospital of Porto Alegre, Porto Alegre, BrazilClinics Hospital of Porto Alegre, Porto Alegre, BrazilClinics Hospital of Porto Alegre, Porto Alegre, BrazilIntroduction and Objectives: Hepatitis C virus (HCV) eradication from dialysis facilities in a community using direct acting antivirals (DAAs) may be achieved more effectively under a collaborative care model, including a network of hepatologists, nephrologists and specialized dialysis staff. This study aimed to evaluate the prevalence of HCV infection in patients undergoing renal replacement therapy in all registered dialysis units operating in Rio Grande do Sul State (RS), in Southern Brazil. Furthermore, to implement a strategy to treat HCV infection locally at these units. Materials and Methods: All dialysis units in RS State were contacted between January 2020 and January 2022 to provide results of anti-HCV screening in dialysis patients. Those with positive results were discussed via telemedicine with a team of two hepatologists and one nephrologist located in Clinics Hospital of Porto Alegre, a tertiary health care facility. Dialysis staff was instructed to test HCV RNA with polymerase chain reaction (PCR) and calculate FIB-4 and APRI scores. Viremic patients were selected for therapy and those with FIB-4 >3.25 and/or APRI >1.5 were required to undergo ultrasonography and/or elastography. DAA therapy was started locally by the dialysis unit staff under the supervision of the hepatologists. Results: A total of 6,991 patients from all 66 dialysis facilities in RS State were enrolled. Most patients (93.3%) were on hemodialysis. All patients completed HCV screening and 454 (6.5%) were anti-HCV positive. So far, nine units have completed the proposed model, with 89 anti-HCV positive patients that resulted in 49 (55.5%) with detectable HCV RNA by PCR. All viremic patients started HCV therapy. Interim analysis showed SVR in 21 (95.5%) of 22 patients. Conclusions: A collaborative care model increased the rates of diagnosis and treatment for HCV in dialysis facilities to levels near those established by the World Health Organization towards HCV elimination up to 2030.http://www.sciencedirect.com/science/article/pii/S1665268123001333 |
| spellingShingle | Hugo Cheinquer Alexandre de Araujo Dirceu da Silva Reis O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZIL Annals of Hepatology |
| title | O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZIL |
| title_full | O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZIL |
| title_fullStr | O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZIL |
| title_full_unstemmed | O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZIL |
| title_short | O-19 COLLABORATIVE CARE TOWARDS MICROELIMINATION OF HEPATITIS C VIRUS IN A DIALYSIS POPULATION IN SOUTHERN BRAZIL |
| title_sort | o 19 collaborative care towards microelimination of hepatitis c virus in a dialysis population in southern brazil |
| url | http://www.sciencedirect.com/science/article/pii/S1665268123001333 |
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