Comparison Stratagems of Post-Screening Management of Anti-HCV-Positive Community Residents: Simple Notification, Active Referral, or Accessible Medical Care

PLoS One. 2015 May 13;10(5):e0126031. doi: 10.1371/journal.pone.0126031. eCollection 2015.

Abstract

To elucidate the results of post-screening care stratagems for anti-hepatitis C virus (HCV)-positive subjects in the community. Part I methods: The intervention program: A total of 151,790 subjects underwent a large-scale healthcare screening. Subjects aged less than 65 years, with anti-HCV-positive and alanine aminotransferase (ALT) level more than 80 IU/L were followed-up to answer a structured questionnaire. Those responders who met the reimbursement criteria of Taiwan's National Health Insurance for anti-HCV treatment were referred for treatment. Part II: The accessible medical care program: In Yujing township, 271 HCV residents who have been screened before were invited to a bi-weekly hepatitis clinic in Yujing health center. Part-I results: A total of 907 anti-HCV-positive subjects responded and 197(21.7%) were advised the treatment, but only 83(9.2%) did. Finally, 47 patients achieved a sustained virological response (SVR). After this intervention program, 96(10.6%) additional patients were encouraged to be referred, 33(3.6%) received treatment and 20 obtained a SVR. Part II: A total of 140(51.7%) subjects responded and 112 were anti-HCV-positive including 31(27.7%) HCV RNA-negative, 49(43.8%) HCV RNA-positive plus ALT less than 40 IU/L and 32(28.5%) HCV RNA-positive plus ALT more than 40 IU/L. During the follow-up, 14 of 49 patients had ALT more than 40 IU/L. Among 46 eligible HCV patients, 15(32.6%) received treatment and 10 achieved a SVR. Simple notification only made 9.2% of the screened HCV patients treat. Active referral could encourage additional 3.6% to be treated. Additionally, accessible medical care program could result in treatment of 32.6% elderly eligible patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use
  • Disease Management
  • Disease Notification
  • Female
  • Health Services Accessibility
  • Hepacivirus / immunology
  • Hepatitis C Antibodies / blood
  • Hepatitis C, Chronic / blood
  • Hepatitis C, Chronic / diagnosis*
  • Hepatitis C, Chronic / drug therapy
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Referral and Consultation

Substances

  • Antiviral Agents
  • Hepatitis C Antibodies

Grants and funding

This study was funded by a grant from Delivery Hope project of Bristol-Myers Squibb Foundation to Dr. Sheng-Nan Lu. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.