Details

Autor(en) / Beteiligte

• Morales-Arraez, Dalia
• Hernández-Bustabad, Alberto
• Medina-Alonso, María Jesús
• Santiago-Gutiérrez, Luz Goretti
• García-Gil, Sara
• Diaz-Flores, Felicitas
• Pérez-Pérez, Víctor
• Nazco, Julia
• Fernandez de Rota Martin, Pilar
• Gutiérrez, Fernando
• Hernández-Guerra, Manuel

Titel

Telemedicine and decentralized hepatitis C treatment as a strategy to enhance retention in care among people attending drug treatment centres

Ist Teil von

• The International journal of drug policy, 2021-08, Vol.94, p.103235-103235, Article 103235

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2021

Quelle

PAIS Index

Beschreibungen/Notizen

• •A healthcare program based on on-site dried blood spot testing for hepatitis C virus (HCV) infection is an effective strategy to diagnose and care patients at drug treatment centres.•Retention in care to the program can be challenged below knowledge about the disease, low awareness of new direct-acting antiviral drug benefits, and economic reasons. However, patients’ knowledge of HCV infection is a predictive factor of complete adherence to the program.•Telemedicine linked to a decentralized dispensation of HCV treatment at drug treatment centres is a useful strategy to re-engage patients lost to follow-up for continuing care. People attending drug treatment centres have a high burden of hepatitis C virus (HCV) and face barriers to diagnosis and treatment. Dried blood spot (DBS) testing has been proposed to simplify diagnosis, but many patients remain untreated. In this retrospective study, we evaluated the reasons for non-retention in care in an intervention using on-site DBS testing and the effect of telemedicine and decentralized care compared to standard of care among people attending drug treatment centres who were lost to follow-up. In a first phase, retention in care, adherence to treatment, and predictive factors in the DBS testing program of patients in drug treatment centres were analyzed and compared to a cohort of patients treated at the hospital outpatient clinic. Subsequently, in a second phase we evaluated in patients lost to follow-up from drug treatment centres the efficacy of one-step testing and telemedicine linked to a decentralized dispensation of HCV treatment or standard of care. Among 512 patients attending drug treatment centres, 467 (91.2%) agreed to be tested and 53.4% (237 patients/444 valid tests) tested positive (46 ± 9 years, 87.3% male) for HCV antibodies. After excluding patients negative for RNA or under surveillance, 178 patients were scheduled to meet with a specialist. Overall, 44 patients did not attend and 25 did not complete the pre-treatment evaluation. The only factor associated with retention in care was patient's knowledge of HCV infection. Treated patients attending drug treatment centres (n = 68) compared to the hospital outpatient clinic cohort (n = 135) had lower rates of treatment adherence. Among the patients who attended drug treatment centres that were lost to follow-up (n = 69), the proportion of patients who completed the program was significantly higher among those assisted by telemedicine than by standard of care (62.5% vs. 24.3%, p = 0.002). Although there was a high participation rate in a DBS testing program in drug treatment centres, non-retention in care is a challenge. Importantly, telemedicine linked to a decentralized dispensation of HCV treatment re-engages patients and may be effective for HCV microelimination.