People who are assisted by Drug Dependence Care Centers have a high risk of high prevalence of infection by the hepatitis C virus and they frequently face difficulties in the diagnosis and treatment of this disease. For this reason, Digestive System Service of the Canary Islands University Hospital Complex (HUC), attached to the Ministry of Health of the Government of the Canary Islands, launched a project in conjunction with the Pharmacy Service, the Central Laboratory and the Drug Addiction Care Centers whose results have been accepted for publication in the prestigious scientific journal, IInternational Journal of Drug Policy.
This is a retrospective study in which an analysis of the obstacles is made and how this project has considerably improved care after having implemented a test that simplifies the diagnosis, the dry drop test, and bet on decentralized care through the telemedicine.
This work has been carried out through the University Institute of Biomedical Technologies CIBICAN with which the Digestive System Services, Central Laboratory and Pharmacy Service of the HUC collaborate together with the Drug Addiction Care Unit ANTAD and San Miguel Addictions.
Keep in mind that people who inject drugs have higher prevalence of hepatitis C virus infection than the general population since injection drug use is the most common route of transmission of this disease. For a few years there have been effective treatments without adverse effects that simplify the cure of this disease. This is very relevant since eradicating the virus is synonymous with stopping complications such as cirrhosis in these patients.
In a first phase of the study, the reasons for abandoning the diagnostic program were analyzed through the dried blood drop test performed in situ in Drug Dependence Care Centers to detect antibodies against hepatitis C virus and adherence to treatment in these patients.
Subsequently, the efficacy of improving the healthcare circuit by performing one-step tests (the dry drop test with direct determination of viral load) and the use of telemedicine linked to a decentralized dispensing of treatment of hepatitis C.
Between 512 patients who attended drug treatment centers and they were asked to participate in the program, 467 (91.2%) agreed to be tested and 53.4% were positive for antibodies against the virus of hepatitis C. After excluding patients without active infection or under follow-up for their disease, 178 patients were scheduled for appointment at the HUC Digestive System Service. Although the patients who received treatment had poorer adherence to it, the cure rate was excellent and equal to the reference rate. A total of 69 patients did not complete the follow-up, being more frequent among these patients the lack of knowledge of the prognosis and advantages of the new antiviral treatments.
Of the patients who lost follow-up and who were proposed to restart evaluation and treatment, the proportion of patients who completed the program was significantly higher among those assisted by telemedicine than by standard of care (62.5% versus 24, 3%).
This study shows that a comprehensive health care program With a simplified healthcare circuit based on tests adapted to the environment such as the dry gout test, telemedicine and the provision of decentralized treatment between Drug Dependence Care Centers and hospital care, it is effective in detection, evaluation and treatment cash of hepatitis C.
Despite these improvements in care, the patients who discontinued follow-up were due to poor knowledge about the disease and the benefits of current direct-acting antiviral drugs and for economic reasons.
The telemedicine Linked to decentralized delivery of hepatitis C virus treatment, it can rescue patients and may be effective for the micro-elimination of this virus.
The head of the Digestive System of the HUC and last signatory of the publication, Manuel Hernández-Guerra, highlights “the joint work of the different teams involved in this project, which arose from a need to overcome obstacles with an innovative proposal from which this prestigious scientific journal specialized in social policies related to health has been echoed ”.
In addition, he points out that “although we observe a high rate of participation in this program, the lack of follow-up of these patients and undoubtedly telemedicine, currently so on the rise with the SARS-2 infection and social distancing, is still a challenge. in this environment it has been very effective ”.
He also pointed out that “this unprecedented study provides a frame of reference so that other centers can join in the example so that we can get closer to the objectives that the World Health Organization has proposed to eliminate hepatitis C, for which I remember there is a cure unlike other viruses ”.