ABSTRACT
Resumen: Introducción: La infección crónica por el virus de la hepatitis C (VHC) es responsable de 400.000 muertes al año, asociadas fundamentalmente al desarrollo de cirrosis y carcinoma hepatocelular. El advenimiento de los nuevos antivirales de acción directa ha marcado un punto de inflexión en el tratamiento del VHC, llevando a casi 100% la curación de los pacientes tratados. En tal sentido, la OMS se ha fijado como objetivos para el año 2030, reducir un 90% las nuevas infecciones por el VHC y un 65% la mortalidad asociada a este virus, para lo cual es necesario el desarrollo de estrategias activas de diagnóstico y vinculación a la atención y tratamiento. El objetivo del trabajo es realizar un diagnóstico de situación de los pacientes infectados por el VHC en el Hospital Central de las Fuerzas Armadas (HCFFAA), e implementar y evaluar una estrategia secuencial de revinculación a la atención. Metodología: Se construyó la cascada de tratamiento mediante una estimación de los pacientes portadores de infección crónica por VHC basada en la prevalencia local y la revisión de historias clínicas de los pacientes asistidos en el servicio de Hepatología y Trasplante Hepático del HCFFAA. Se implementó una estrategia para contactar a los pacientes con infección por VHC de forma secuencial, buscando re-establecer el vínculo de estos con el servicio de salud, asegurando el acceso a la estadificación de la enfermedad hepática y al tratamiento antiviral. Resultados: La prevalencia global estimada de personas con infección crónica por VHC fue de 1.008 personas. De 135 pacientes con serología positiva, 113 tenían ARN confirmatorio, 76 habían recibido tratamiento y 70 habían alcanzado respuesta virológica sostenida. La implementación de la estrategia logró un aumento en la prescripción del tratamiento del 67% a 76% de los pacientes con infección crónica por VHC confirmada. Conclusiones: La implementación de la estrategia de revinculación fue exitosa, con un aumento de la prescripción del tratamiento antiviral en los pacientes candidatos a tratamiento. La búsqueda activa de los pacientes infectados no diagnosticados mediante el cribado es el siguiente paso para alcanzar los objetivos de erradicación.
Abstract: Introduction: Chronic infection by the hepatitis C virus (HCV) is responsible for 400,000 deaths per year, mainly associated with the development of cirrhosis and hepatocellular carcinoma. The advent of new direct-acting antivirals has marked a turning point in the treatment of HCV, leading to almost 100% cure of treated patients. In this sense, the WHO has set as objectives for the year 2030, to reduce new HCV infections by 90% and the mortality associated with this virus by 65%, for which it is necessary to develop active strategies for diagnosis and linkage to care and treatment. The objective of the work is to carry out a diagnosis of the situation of the patients infected by HCV in the Central Hospital of the Armed Forces (HCFFAA), and to implement and evaluate a sequential strategy of re-attachment to care. Methodology: The treatment cascade was constructed by estimating the number of patients with chronic HCV infection based on local prevalence and review of the medical records of patients seen in the Hepatology and Liver Transplant service of the HCFFAA. A strategy was implemented to contact patients with HCV infection sequentially, seeking to re-establish their link with the health service, ensuring access to liver disease staging and antiviral treatment. Results: The estimated global prevalence of people with chronic HCV infection was 1,008 people. Of 135 patients with positive serology, 113 had confirmatory RNA, 76 had received treatment, and 70 had achieved sustained virologic response. The implementation of the strategy achieved an increase in the prescription of treatment from 67% to 76% of patients with confirmed chronic HCV infection. Conclusions: The implementation of the rebinding strategy was successful, with an increase in the prescription of antiviral treatment in patients who are candidates for treatment. Active search for undiagnosed infected patients through screening is the next step to achieve eradication goals.
Resumo: Introdução: A infecção crônica pelo vírus da hepatite C (HCV) é responsável por 400.000 óbitos por ano, principalmente associada ao desenvolvimento de cirrose e carcinoma hepatocelular. O advento de novos antivirais de ação direta marcou um ponto de virada no tratamento do HCV, levando à cura de quase 100% dos pacientes tratados. Nesse sentido, a OMS estabeleceu como objetivos para o ano de 2030, reduzir em 90% as novas infecções por HCV e a mortalidade associada a este vírus em 65%, para o que é necessário desenvolver estratégias ativas de diagnóstico e vinculação aos cuidados e tratamento. O objetivo do trabalho é realizar um diagnóstico da situação dos pacientes infectados pelo HCV no Hospital Central das Forças Armadas (HCFFAA), e implementar e avaliar uma estratégia sequencial de reinserção aos cuidados. Metodologia: A cascata de tratamento foi construída estimando o número de pacientes com infecção crônica pelo HCV com base na prevalência local e revisão dos prontuários dos pacientes atendidos no serviço de Hepatologia e Transplante de Fígado do HCFFAA. Foi implantada uma estratégia de contato sequencial dos pacientes com infecção pelo HCV, buscando restabelecer o vínculo com o serviço de saúde, garantindo o acesso ao estadiamento da doença hepática e ao tratamento antiviral. Resultados: A prevalência global estimada de pessoas com infecção crônica pelo HCV foi de 1.008 pessoas. Dos 135 pacientes com sorologia positiva, 113 tiveram RNA confirmatório, 76 receberam tratamento e 70 alcançaram resposta virológica sustentada. A implementação da estratégia conseguiu um aumento na prescrição de tratamento de 67% para 76% dos pacientes com infecção crônica pelo HCV confirmada. Conclusões: A implementação da estratégia de religação foi bem sucedida, com aumento da prescrição do tratamento antiviral em pacientes candidatos ao tratamento. A busca ativa de pacientes infectados não diagnosticados por meio de triagem é o próximo passo para atingir as metas de erradicação.
ABSTRACT
Objective:To explore the impact of multidisciplinary transitional nursing on AIDS patients' nursing participation, nursing continuation and virus suppression.Methods:A total of 322 patients with AIDS who were hospitalized in the Infection Department of Dalian Sixth People's Hospital from March 2014 to March 2018 were selected and randomly divided into general nursing group and multidisciplinary transitional nursing group with 161 cases in each group. The demographic and clinical data of each patient were recorded and compared, and the barriers of patients to participate in nursing and medical consultation were recorded. Consulted The patients were consulted about the nursing participation before hospitalization and the times of nursing continuation. After one year of follow-up, the number of cases of nursing participation, nursing continuity and virus suppression were recorded. The differences between the two groups were compared. The patients in the multidisciplinary transitional care group were divided into three subgroups after discharge, and the comparison between the subgroups was made. Multivariate Logistic regression analysis was performed.Results:In the multidisciplinary nursing group, 119 cases (81.51%, 119 / 146) and 105 cases (71.92%, 105 / 146) were involved in nursing and 105 cases (71.92%, 105/146) in the multidisciplinary nursing group, and 100 cases (62.11%, 100/161) and 90 cases (55.90%, 90/161) in the general nursing group 1 year after discharge, respectively. The difference between the two groups was statistically significant ( χ2 value was 14.09, 8.48, P<0.05). There was a significant difference in the number of cases in the multidisciplinary transitional care group without consulting the subgroup, only the medical and nursing consulting subgroup and medical, and the nursing and social support consulting subgroup in nursing participation, nursing continuation and increased viral suppression ( χ2 value was 22.90, 37.21, 23.07, P<0.05). The results of the regression model suggested that patients with medical and nursing consultation only, patients with medical, nursing, and social consultation had OR value of 1.67 and 1.89 compared with patients without consultation. The OR value was 1.35 and 1.76, which were significantly different. Conclusions:Through multidisciplinary transitional nursing, it can significantly improve nursing participation and nursing continuity and can improve virus suppression.