Provider education, point-of-care antibody testing benefit patients with HCV
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A range of interventions improved testing, linkage to care and treatment initiation in patients with hepatitis C, according to a study published in The Lancet Gastroenterology & Hepatology.
“The advent of direct acting antiviral (DAA) therapy for HCV treatment has been one of the greatest clinical breakthroughs in decades, allowing for optimism that HCV could be eliminated globally,” Evan B. Cunningham, PhD, associate lecturer in the viral hepatitis clinical research program at the Kirby Institute in Australia, told Healio. “Since DAAs have become commonplace, considerable research has been done to optimise models of HCV care; however, there had been no systematic review to pull everything together. This review sought to highlight those interventions that could be most effective as progressing the push towards HCV elimination.”
Seeking to better understand the efficacy of evidence-based interventions, Cunningham and colleagues conducted a systemic review and meta-analysis of 148 studies (47 randomized controlled trials and 101 non-randomized studies), which they sourced from MEDLINE (PubMed), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials and PsycINFO from database inception to July 2020. Primary outcomes included HCV antibody testing, HCV RNA testing, linkage to HCV care and direct-acting antiviral treatment initiation.
“There were three broad categories of interventions that were most effective,” Cunningham said. “Those that simplified testing, making it easier for patients to engage with care, those that enhanced patient engagement with care by simplifying care and overcoming patient barriers to care, and those that enhanced provider engagement in care by improving provider confidence and motivation to engage in HCV care."
Compared with a comparator or control, medical chart reminders, provider education and point-of-care antibody testing significantly improved at least three stages of HCV care cascade. Dried blood spot testing, point-of-care antibody testing, reflex RNA testing and opt-out screening — all of which simplify HCV testing — also significantly improved testing outcomes, as did enhanced patient and provider support through patient education, provider education and provider care coordination.
In addition, linkage to care and the uptake of direct-acting antiviral treatment were significantly improved through integrated care and patient navigation or care coordination, compared with a comparator or control.
“A host of interventions were identified that address the critical barriers to care faced by populations affected by HCV,” Cunningham told Healio. “When thoughtfully targeted to populations in need of HCV care, these interventions have the potential to greatly enhance progress towards HCV elimination. Further research, including robustly-designed randomized controlled trials and studies conducted in low- and middle-income countries, are needed to affect global health policy and achieve HCV elimination.”
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