Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1576
Peer-review started: August 1, 2021
First decision: September 29, 2021
Revised: November 1, 2021
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 27, 2022
An estimated 230 000 Australians were living with hepatitis C virus (HCV) in 2006. The advent of direct acting antiviral (DAA) therapy has revolutionized treatment paradigms and greatly improved rates of sustained virological response. Nevertheless, several challenges remain in striving for the goal of HCV elimination by 2030.
Multifaceted interventions and approaches are required to maintain momentum in order to achieve HCV elimination by 2030. Contemporary discourse in cascades of viral hepatitis care focus on expanding testing as the primary means for identifying and treating remaining HCV patients. Enhancing testing infrastructure and introducing systematic viral assessments in correctional facilities, needle exchange programmes, homeless shelters and in high-risk communities are examples of initiatives currently being undertaken. Less attention has been given to linking patients with pre-existing diagnoses of HCV back to care. Inpatient hospital admissions represent an excellent opportunity to identify and treat both newly and previously diagnosed HCV patients.
To assess whether patients with HCV admitted to a tertiary Australian hospital were appropriately referred on for treatment. Our study was designed to assess the extent to which current hospital practices maximise opportunity for identifying and treating patients with HCV.
Our study constituted a retrospective cohort study that assessed patients with HCV admitted to The Queen Elizabeth Hospital, Adelaide in 2017. The primary outcome of our study was referral of patients for HCV treatment. Secondary outcomes included assessment of factors predicting treatment referral.
There were 148 patients with active hepatitis C. Overall, 131 patients of our study cohort were deemed eligible for DAA treatment and included in the main analysis. Thirty-two patients (24%) were referred on for treatment of their HCV infection. The odds ratio (OR) for appropriate referral for physician specialties versus nonphysician specialties was 7.2 (95% CI: 3.0–17.1, P < 0.0001). Older patients (OR: 1.05, 95% CI: 1.05–1.08, P = 0.097) and those with liver cirrhosis (OR: 19.0, 95% CI: 3.7–96.3, P = 0.0004) were significantly more likely to be referred on for treatment. Thirteen patients referred to gastroenterology or infectious diseases clinics commenced treatment.
Hepatitis C remains an important public health issue. The advent of state subsidised DAA therapy has transformed the therapeutic landscape of hepatitis C in Australia. Despite this, patient engagement and social issues remain important barriers to the elimination of hepatitis C. Our study found that 76% of chronic hepatitis C patients presenting to the inpatient services of our tertiary hospital were not referred on for treatment. Furthermore, DAA treatment was initiated in less than half of referred patients. This suggests that current hospital practices are not adequately identifying patients with HCV. Hospital admissions constitute an excellent opportunity to identify and treat patients with chronic hepatitis C. Extrapolating this study across tertiary healthcare institutions in Australia and overseas would facilitate re-engagement of previously diagnosed HCV patients with care cascade and supplement overall treatment numbers.
Our study has internationally relevant implications as our methodology provides a template for systematically identifying HCV patients from inpatient cohorts. Extrapolating this across other national and international tertiary healthcare institutions will serve to supplement treatment rates of HCV as we strive to achieve goals of HCV elimination. Our findings also demonstrate that identification of HCV patients is necessary but not in itself sufficient to achieve cure of HCV. Proactive measures are required to ensure that identified patients successfully commence and complete treatment courses. Hospitals thus require comprehensive multifaceted approaches to ensure opportunities for treatment are taken advantage of.