부산대학교 도서관

Background: The Eastern European country of Georgia initiated a nationwide hepatitis C virus (HCV) elimination program in 2015 to address a high burden of infection. Screening for HCV infection through antibody testing was integrated into multiple existing programs, including the National Tuberculosis Program (NTP). We sought to compare the hepatitis C care cascade among patients with and without tuberculosis (TB) diagnosis in Georgia between 2015 and 2019 and to identify factors associated with loss to follow-up (LTFU) in hepatitis C care among patients with TB. Methods and findings: Using national ID numbers, we merged databases of the HCV elimination program, NTP, and national death registry from January 1, 2015 to September 30, 2020. The study population included 11,985 adults (aged ≥18 years) diagnosed with active TB from January 1, 2015 through December 31, 2019, and 1,849,820 adults tested for HCV antibodies between January 1, 2015 and September 30, 2020, who were not diagnosed with TB during that time. We estimated the proportion of patients with and without TB who were LTFU at each step of the HCV care cascade and explored temporal changes. Among 11,985 patients with active TB, 9,065 (76%) patients without prior hepatitis C treatment were tested for HCV antibodies, of which 1,665 (18%) had a positive result; LTFU from hepatitis C care was common, with 316 of 1,557 (20%) patients with a positive antibody test not undergoing viremia testing and 443 of 1,025 (43%) patients with viremia not starting treatment for hepatitis C. Overall, among persons with confirmed viremic HCV infection, due to LTFU at various stages of the care cascade only 28% of patients with TB had a documented cure from HCV infection, compared to 55% among patients without TB. LTFU after positive antibody testing substantially decreased in the last 3 years, from 32% among patients diagnosed with TB in 2017 to 12% among those diagnosed in 2019. After a positive HCV antibody test, patients without TB had viremia testing sooner than patients with TB (hazards ratio [HR] = 1.46, 95% confidence intervals [CI] [1.39, 1.54], p < 0.001). After a positive viremia test, patients without TB started hepatitis C treatment sooner than patients with TB (HR = 2.05, 95% CI [1.87, 2.25], p < 0.001). In the risk factor analysis adjusted for age, sex, and case definition (new versus previously treated), multidrug-resistant (MDR) TB was associated with an increased risk of LTFU after a positive HCV antibody test (adjusted risk ratio [aRR] = 1.41, 95% CI [1.12, 1.76], p = 0.003). The main limitation of this study was that due to the reliance on existing electronic databases, we were unable to account for the impact of all confounding factors in some of the analyses. Conclusions: LTFU from hepatitis C care after a positive antibody or viremia test was high and more common among patients with TB than in those without TB. Better integration of TB and hepatitis C care systems can potentially reduce LTFU and improve patient outcomes both in Georgia and other countries that are initiating or scaling up their nationwide hepatitis C control efforts and striving to provide personalized TB treatment. In an observational cohort study from Georgia, Davit Baliashvili and colleagues explore whether patients with tuberculosis receive complete and timely treatment for hepatitis C. Author summary: Why was this study done?: There is ample evidence that hepatitis C prevalence is disproportionally high among patients with tuberculosis (TB). Highly effective new treatment options for hepatitis C allowed many countries, including Georgia, to implement large-scale hepatitis C programs. It has not been well characterized how often patients with current or past TB are offered and provided with hepatitis C testing and treatment services. What did the researchers do and find?: We conducted an observational cohort study comparing the hepatitis C care cascade among patients with and without TB to explore if patients with tuberculosis receive hepatitis C treatment completely and timely. The proportion of patients with TB tested for hepatitis C virus (HCV) antibodies increased per year. Among patients diagnosed with TB in 2015, 60% were tested for HCV antibodies sometime during the study period. This proportion reached 90% among patients diagnosed with TB in 2019 Loss to follow-up (LTFU) from hepatitis C care was more common among patients with TB, with 20% of patients with a positive antibody test not undergoing viremia testing and 43% of patients with viremia not starting treatment for hepatitis C. For comparison, the respective numbers among patients without TB were 14% and 19%. What do these findings mean: Our findings highlight the importance of improving integration and linkage to hepatitis C diagnostic and treatment services among patients with TB. Existing large-scale public health programs for both TB and hepatitis C in Georgia and other countries with nationwide programs create a unique opportunity for integrated care of these 2 infectious diseases, which could potentially reduce LTFU and improve overall health outcomes. [ABSTRACT FROM AUTHOR]