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Use of interventions improves patient care for viral hepatitis
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Researchers recommend multiple, inexpensive interventions be included in screening, diagnosis and treatment programs for patients with hepatitis B and C viruses, in an effort to optimize the outcomes of hepatitis care, according to new data published in The Lancet Infectious Diseases.
“Given the huge need for expanding HBV/HCV testing around the world, research to inform the development of public health interventions to encourage testing and onward steps are critical,” Joseph D. Tucker, MD, PhD, co-director, University of North Carolina-South China STI Research Training Center, Guangzhou, China, told Infectious Disease News. “Our systematic review identified a number of relatively inexpensive, simple interventions to promote hepatitis B and C testing and downstream steps of the chronic hepatitis care continuum.”
Joseph D. Tucker
Tucker and colleagues analyzed randomized controlled trials and controlled nonrandomized studies that examined operational interventions along the chronic viral hepatitis care continuum published up until Dec. 31, 2014. They included 56 studies (41 for HCV, 18 for HBV) from PubMed, Embase, WHO library, International Clinical Trials Registry Platform, PsycINFO, and CINAHL in the final analysis. With one exception, all the studies were from high-income countries.
Tucker and colleagues found that lay health worker HBV test promotion interventions were effective for increasing HBV testing rates (RR = 2.68; 95% CI, 1.82-3.93), and guided referral for HCV increased patient attendance to visits with an HCV specialist compared with no referral (RR = 1.57; 95% CI, 1.03-2.41).
HCV education and pre-test counseling with on-site testing by health care professionals at facilities serving high-risk populations increased HCV testing compared with no education or counseling (RR = 2.77; 95% CI, 1.11-6.93). The researchers noted all facilities were different throughout the studies.
“Individuals assigned to clinicians who received reminders were 3.7 times as likely [95% CI, 1.81-7.57] as those assigned to clinicians who did not receive reminders to get HCV testing,” Tucker said.
In addition, the researchers determined that when nurses performed educational interventions, HCV treatment improved (RR =1.14; 95% CI, 1.05-1.23) as did cure rates (OR = 1.93; 95% CI, 1.44-2.59). Compared with standard care, coordinated mental health, substance misuse and hepatitis treatment services increased HCV treatment uptake (OR = 3.03; 95% CI, 1.24-7.37), adherence (RR = 1.22; 95% CI, 1.05-1.41) and cure (RR = 1.21; 95% CI, 1.07-1.38).
“Operational interventions should be included in chronic viral hepatitis screening, diagnosis and treatment programs to optimize outcomes of hepatitis care,” the researchers concluded.
John W. Ward
John W. Ward, MD, director of the CDC’s Division of Viral Hepatitis, called the need for effective interventions crucial and this analysis a “benchmark endeavor” for the elimination of viral hepatitis, in an accompanying editorial.
“The analysis by Zhou and colleagues identifies proven strategies that can be widely adopted and become standard elements of a package of services to be considered for use in elimination programs. … This analysis arrives at a crucial time for public health,” Ward wrote.
Despite the effective interventions, Ward said more data are needed, and many gaps persist in their implementation.
“Studies of interventions that improve HBV testing in clinical settings or HBV treatment uptake and adherence are absent. Safe, curative HCV therapies increase opportunities for expanding access to HCV treatment to prevent both HCV-associated disease and transmission, few data are available to guide best use of transformative HCV drugs,” Ward wrote. – by Melinda Stevens
Disclosure: The researchers and Ward report no relevant financial disclosures.
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