Strategies to improve outcomes in the hepatitis c cascade of care

  1. Morales Arraez, Dalia Elena
Dirixida por:
  1. Manuel Hernández Guerra Director

Universidade de defensa: Universidad de La Laguna

Fecha de defensa: 06 de febreiro de 2020

Tribunal:
  1. Rajiv Jalan Presidente/a
  2. Antonio Isaac Martín Malagón Secretario
  3. Raúl J. Andrade Bellido Vogal
Departamento:
  1. Medicina Interna, Dermatología y Psiquiatría

Tipo: Tese

Teseo: 614853 DIALNET

Resumo

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.