Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2022; 14(8): 1576-1583
Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1576
Missed opportunities for hepatitis C treatment at a tertiary care hospital in South Australia
Sreecanth Sibhi Raja, Suzanne Edwards, Jeffrey Stewart, Dep Huynh
Sreecanth Sibhi Raja, Jeffrey Stewart, Dep Huynh, Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville 5011, South Australia, Australia
Suzanne Edwards, Department of Statistician, School of Public Health, University of Adelaide, Adelaide 5000, South Australia, Australia
Author contributions: Raja SS contributed to study conception and design, also contributed to data collection and analysis as well as drafting and revision of the manuscript; Huyn D contributed to study design, supervision, data analysis and manuscript preparation; Stewart J contributed to data collection and analysis; Edwards S performed statistical analysis.
Institutional review board statement: This retrospective cohort study was completed in accordance with the guidelines set by the South Australian Health Research Governance Policy Directive.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous de-identified data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sreecanth.raja@sa.gov.au. Individual consent was not obtained but the presented data is de-identified without risk of identification.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sreecanth Sibhi Raja, MBBS, Research Fellow, Department of Gastroenterology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville 5011, South Australia, Australia. sreecanth.raja@sa.gov.au
Received: August 1, 2021
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
Processing time: 390 Days and 7.4 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.