Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries
Objectives Given limited data on factors associated with hepatitis C virus (HCV) treatment discontinuation and failure in low- and middle-income countries, we aimed to describe patient populations treated for HCV in five countries and identify patient groups that may need additional support.Design R...
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BMJ Publishing Group
2022-12-01
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| author | Caroline E Boeke Clement Adesigbin Chukwuemeka Agwuocha Atiek Anartati Khin Sanda Aung Gagandeep Singh Grover Dang Ngo Siddharth Sindhwani Craig McClure Christian B Ramers Olayinka Adisa Muhammad-Mujtaba Akanmu Amy Azania Ruth Bello Nabe Arief Budiman Yuhui Chan Umesh Chawla Fatchanuraliyah Oriel Fernandes Thandar Su Naing Sean Regan Gertrudis Tandy Khin Tint Kinh Van Nguyen Magdalena Witschi |
| author_facet | Caroline E Boeke Clement Adesigbin Chukwuemeka Agwuocha Atiek Anartati Khin Sanda Aung Gagandeep Singh Grover Dang Ngo Siddharth Sindhwani Craig McClure Christian B Ramers Olayinka Adisa Muhammad-Mujtaba Akanmu Amy Azania Ruth Bello Nabe Arief Budiman Yuhui Chan Umesh Chawla Fatchanuraliyah Oriel Fernandes Thandar Su Naing Sean Regan Gertrudis Tandy Khin Tint Kinh Van Nguyen Magdalena Witschi |
| author_sort | Caroline E Boeke |
| collection | DOAJ |
| description | Objectives Given limited data on factors associated with hepatitis C virus (HCV) treatment discontinuation and failure in low- and middle-income countries, we aimed to describe patient populations treated for HCV in five countries and identify patient groups that may need additional support.Design Retrospective cohort analysis using routinely collected data.Setting Public sector HCV treatment programmes in India (Punjab), Indonesia, Myanmar, Nigeria (Nasarawa) and Vietnam.Participants 104 957 patients who initiated treatment in 2016–2022 (89% from Punjab).Primary outcomes Treatment completion and cure.Results Patient characteristics and factors associated with outcomes varied across countries and facilities. Across all patients, median age was 40 years (IQR: 29–52), 30.6% were female, 7.0% reported a history of injecting drugs, 18.2% were cirrhotic and 4.9% were coinfected with HIV. 79.8% were prescribed sofosbuvir+daclastasvir. Of patients with adequate follow-up, 90.6% (89,551) completed treatment. 77.5% (69,426) of those who completed treatment also completed sustained virological testing at 12 weeks (SVR12), and of those, 92.6% (64 305) were cured. In multivariable-adjusted models, in most countries, significantly lower treatment completion was observed among patients on 24-week regimens (vs 12-week regimens) and those initiated in later years of the programme. In several countries, males, younger patients <20 years and certain groups of cirrhotic patients were less likely to complete treatment or be cured. In Punjab, treatment completion was also lower in those with a family history of HCV and people who inject drugs (PWID); in other countries, outcomes were comparable for PWID.Conclusion High proportions of patients completed treatment and were cured across patient groups and countries. SVR12 follow-up could be strengthened. Males, younger people and those with decompensated cirrhosis on longer regimens may require additional support to complete treatment and achieve cure. Adequate programme financing, minimal user fees and implementation of evidence-based policies will be critical to close gaps. |
| format | Article |
| id | doaj-art-60e95e9faa134205a5824e093c7a3fe6 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-60e95e9faa134205a5824e093c7a3fe62025-08-20T03:53:03ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2022-062745Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countriesCaroline E Boeke0Clement Adesigbin1Chukwuemeka Agwuocha2Atiek Anartati3Khin Sanda Aung4Gagandeep Singh Grover5Dang Ngo6Siddharth Sindhwani7Craig McClure8Christian B Ramers9Olayinka Adisa10Muhammad-Mujtaba Akanmu11Amy Azania12Ruth Bello Nabe13Arief Budiman14Yuhui Chan15Umesh Chawla16 Fatchanuraliyah17Oriel Fernandes18Thandar Su Naing19Sean Regan20Gertrudis Tandy21Khin Tint22Kinh Van Nguyen23Magdalena Witschi24Clinton Health Access Initiative, Boston, Massachusetts, USANational AIDS/STIs Control Programme, Federal Ministry of Health, Nigeria, Abuja, NigeriaClinton Health Access Initiative, Abuja, NigeriaClinton Health Access Initiative, Jakarta, Indonesia8 National Hepatitis Control Program, Department of Public Health, Ministry of Health and Sports, Yangon, MyanmarDepartment of Health and Family Welfare, National Viral Hepatitis Control Program, Government of Punjab, Chandigarh, IndiaClinton Health Access Initiative, Hanoi, Viet NamClinton Health Access Initiative, Delhi, IndiaClinton Health Access Initiative, Boston, Massachusetts, USAFamily Health Centers of San Diego, San Diego, California, USAClinton Health Access Initiative, Abuja, NigeriaClinton Health Access Initiative, Abuja, NigeriaClinton Health Access Initiative, Boston, Massachusetts, USANasarawa State AIDS Control Agency, Nasarawa, NigeriaClinton Health Access Initiative, Jakarta, IndonesiaClinton Health Access Initiative, Boston, Massachusetts, USAClinton Health Access Initiative, Delhi, IndiaDirectorate of Communicable Disease Prevention and Control, Ministry of Health of the Republic of Indonesia, Jakarta, IndonesiaClinton Health Access Initiative, Boston, Massachusetts, USAClinton Health Access Initiative, Yangon, MyanmarClinton Health Access Initiative, Boston, Massachusetts, USADirectorate of Communicable Disease Prevention and Control, Ministry of Health of the Republic of Indonesia, Jakarta, IndonesiaClinton Health Access Initiative, Yangon, MyanmarNational Hospital of Tropical Diseases, Hanoi, Viet NamClinton Health Access Initiative, Boston, Massachusetts, USAObjectives Given limited data on factors associated with hepatitis C virus (HCV) treatment discontinuation and failure in low- and middle-income countries, we aimed to describe patient populations treated for HCV in five countries and identify patient groups that may need additional support.Design Retrospective cohort analysis using routinely collected data.Setting Public sector HCV treatment programmes in India (Punjab), Indonesia, Myanmar, Nigeria (Nasarawa) and Vietnam.Participants 104 957 patients who initiated treatment in 2016–2022 (89% from Punjab).Primary outcomes Treatment completion and cure.Results Patient characteristics and factors associated with outcomes varied across countries and facilities. Across all patients, median age was 40 years (IQR: 29–52), 30.6% were female, 7.0% reported a history of injecting drugs, 18.2% were cirrhotic and 4.9% were coinfected with HIV. 79.8% were prescribed sofosbuvir+daclastasvir. Of patients with adequate follow-up, 90.6% (89,551) completed treatment. 77.5% (69,426) of those who completed treatment also completed sustained virological testing at 12 weeks (SVR12), and of those, 92.6% (64 305) were cured. In multivariable-adjusted models, in most countries, significantly lower treatment completion was observed among patients on 24-week regimens (vs 12-week regimens) and those initiated in later years of the programme. In several countries, males, younger patients <20 years and certain groups of cirrhotic patients were less likely to complete treatment or be cured. In Punjab, treatment completion was also lower in those with a family history of HCV and people who inject drugs (PWID); in other countries, outcomes were comparable for PWID.Conclusion High proportions of patients completed treatment and were cured across patient groups and countries. SVR12 follow-up could be strengthened. Males, younger people and those with decompensated cirrhosis on longer regimens may require additional support to complete treatment and achieve cure. Adequate programme financing, minimal user fees and implementation of evidence-based policies will be critical to close gaps.https://bmjopen.bmj.com/content/12/12/e062745.full |
| spellingShingle | Caroline E Boeke Clement Adesigbin Chukwuemeka Agwuocha Atiek Anartati Khin Sanda Aung Gagandeep Singh Grover Dang Ngo Siddharth Sindhwani Craig McClure Christian B Ramers Olayinka Adisa Muhammad-Mujtaba Akanmu Amy Azania Ruth Bello Nabe Arief Budiman Yuhui Chan Umesh Chawla Fatchanuraliyah Oriel Fernandes Thandar Su Naing Sean Regan Gertrudis Tandy Khin Tint Kinh Van Nguyen Magdalena Witschi Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries BMJ Open |
| title | Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries |
| title_full | Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries |
| title_fullStr | Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries |
| title_full_unstemmed | Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries |
| title_short | Patient outcomes in public sector hepatitis C treatment programmes: a retrospective cohort analysis across five low- and middle-income countries |
| title_sort | patient outcomes in public sector hepatitis c treatment programmes a retrospective cohort analysis across five low and middle income countries |
| url | https://bmjopen.bmj.com/content/12/12/e062745.full |
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