Screening, Linkage to Care and Treatment of Hepatitis C Infection in Primary Care Setting in the South of Italy.

Anna Citarella,Ugo Trama,Maria D’Antò,Carmine Sellitto,Mario Masarone,Simona Cammarota,Elio Giusto,Marcello Persico,Laura Staiano,Marianna Fogliasecca,Rosa Servodio,Massimo Smaldone,Angelo Salomone Megna,Francesca F Bernardi,Valeria Conti,Carmine Coppola

doi:10.3390/life10120359

Abstract

Hepatitis C virus (HCV) infection remains a pressing public health issue. Our aim is to assess the linkage to care of patients with HCV diagnosis and to support the proactive case-finding of new HCV-infected patients in an Italian primary care setting. This was a retrospective cohort study of 44 general practitioners (GPs) who managed 63,955 inhabitants in the Campania region. Adults with already known HCV diagnosis or those with HCV high-risk profile at June 2019 were identified and reviewed by GPs to identify newly diagnosed of HCV and to assess the linkage to care and treatment for the HCV patients. Overall, 698 HCV patients were identified, 596 with already known HCV diagnosis and 102 identified by testing the high-risk group (2614 subjects). The 38.8% were already treated with direct-acting antivirals, 18.9% were referred to the specialist center and 42.3% were not sent to specialist care for treatment. Similar proportions were found for patients with an already known HCV diagnosis and those newly diagnosed. Given that the HCV infection is often silent, case-finding needs to be proactive and based on risk information. Our findings suggested that there needs to be greater outreach, awareness and education among GPs in order to enhance HCV testing, linkage to care and treatment.

Highlights

Hepatitis C virus (HCV) infection is a global health and economic problem due to its substantial impact on morbidity and mortality [1,2]
3.9% (102/2614) were found to have an hepatitis C virus (HCV) infection, corresponding to 0.2% (102/63,955) of the total population covered by the general practitioners (GPs)
When we stratified by advanced liver disease, we found subjects not treated with direct-acting antivirals (DAAs) and not referred to the specialist center was higher than 40% in patients that 37.1% of HCV patients without advanced liver disease were already treated with DAAs, 18.4%

Summary

Introduction

Hepatitis C virus (HCV) infection is a global health and economic problem due to its substantial impact on morbidity and mortality [1,2]. 30% of HCV patients chronically infected may progress to cirrhosis in their lifetime, whereas 3–8% of cirrhotic patients may develop hepatocellular carcinoma (HCC) [3,4]. The progression to cirrhosis is often clinically silent and, as a result, many HCV patients do not come forward until cirrhosis, liver decompensation or HCC occurs [5,6,7]. The achievement of SVR has the potential benefits of risk reduction of liver disease progression, leading to better long-term clinical outcomes and improved health-related quality of life [9]. On this basis, in 2016, the World

Objectives

Methods

Results

Conclusion