Strategies to improve outcomes in the hepatitis c cascade of care

  1. Dalia Elena Morales Arráez
Supervised by:
  1. Manuel Hernández Guerra Director

Defence university: Universidad de La Laguna

Year of defence: 2020

Committee:
  1. Rajiv Jalan Chair
  2. Antonio Isaac Martín Malagón Secretary
  3. Raúl J. Andrade Bellido Committee member
Department:
  1. Medicina Interna, Dermatología y Psiquiatría

Type: Thesis

Teseo: 614853 DIALNET

Abstract

The aims of this Thesis were to investigate the effect of media coverage in HCV screening in a first study, to evaluate the risk of liver fibrosis progression in subjects with suboptimal diagnosis in a second study, and to determine predictive factor for non-RNA request and the impact of the incorporation of an automatic alert with recommendations in clinical practice in a third study. The results of this thesis showed a significant positive correlation between the number of news related to HCV and HCV testing in the more recent non-interferon era, where news related to treatment with a positive tone were more frequent. Around half of the newly diagnosed anti-HCV positive patients do not have RNA testing after a long follow-up period, and these patients were more frequently men, alcohol and drug users and lacking social support. Patients unaware of their RNA status have high rates of advanced fibrosis and cirrhosis and exhibited a 3- and a 4-fold increase in their risk of at least significant fibrosis and cirrhosis, respectively, being the non-RNA request a predictor for developing cirrhosis.Primary-care serology request, no history of drug use and lack of social support were independent predictors for not undergoing RNA testing. After the implementation of a automatic electronic alert in our clinical information system, the time for RNA testing was shorter, and there was a decrease in the rate of patients without RNA test, and a increase in the rate of referrals to specialist care.