Referral and counseling to the person with HCV
Abstract
Introduction/Objective: The Specialized & Technical Treatment Team (ETET) of Barreiro (Portugal) implemented an intervention to refer people living with hepatitis C virus (HCV) infection to the specialty care of Centro Hospitalar Barreiro Montijo (CHBM). The primary objective of this study was to compare the proportion of individuals who successfully completed the treatment (cure was defined as sustained virologic response, SVR) before and after this intervention.
Methods: The intervention aimed the referral of HCV infected individuals, who are being assisted at the ETET (the majority of them are on therapeutic substitution programmes, with opioid agonists and antagonists) towards HCV-specific care for further evaluation and treatment, and has included: a special and sustained link between ETET and the CHBM Internists/ID physicians, in order to simplify and reduce steps on the treatment cascade; the centralization of the entire referral process in 2 ETET nurses; a personalized nursing consultation focusing on health literacy and on promoting adherence to treatment (monitoring the therapeutic use and reinforcing relevant information for a successful treatment process). In December 2018, the proportion of individuals who achieved SVR12 and were linked to the HCV care cascade (i.e. had at least one clinical specialty consultation after referral) were compared before and after the implementation of the intervention in April 2017.
Results: The number of individuals with positive HCV serology followed in ETET was 403 as of March 2017, and 391 from March 2017 to December 2018. The proportion of individuals who achieved SVR12 increased from 15.1% (n = 61) to 27.8% (n = 112), and the proportion of individuals enrolled in the health care cascade increased from 40.9% (n = 165) to 64.8% (n = 261).
Conclusion: This optimization of resources and increased coordination between both health institutions, as well as the personalized intervention, were associated with a positive impact on the treatment completion for the HCV infection in this population. The nursing consultation was fundamental in achieving these results, since the successful treatment of people who use drugs depends on having an adapted response to their specific needs. It is extremely important to identify which stage of life the person is at, to consider risk and protection factors, in a perspective of gains in health and social well-being, in order to most effectively deliver treatment and maximize treatment outcomes.