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Telemedicine Improves HCV Elimination among Italian People Who Use Drugs: An Innovative Therapeutic Model to Increase the Adherence to Treatment into Addiction Care Centers Evaluated before and during the COVID-19 Pandemic.
Rosato, Valerio; Nevola, Riccardo; Conturso, Vincenza; Perillo, Pasquale; Mastrocinque, Davide; Pappalardo, Annalisa; Le Pera, Teresa; Del Vecchio, Ferdinando; Claar, Ernesto.
  • Rosato V; Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy.
  • Nevola R; Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy.
  • Conturso V; DS32 (Distretto Sanitario N. 32), Ser.D. Unit, ASL Napoli 1 Centro, 80147 Naples, Italy.
  • Perillo P; Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy.
  • Mastrocinque D; Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy.
  • Pappalardo A; Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy.
  • Le Pera T; DS32 (Distretto Sanitario N. 32), Ser.D. Unit, ASL Napoli 1 Centro, 80147 Naples, Italy.
  • Del Vecchio F; DS32 (Distretto Sanitario N. 32), Ser.D. Unit, ASL Napoli 1 Centro, 80147 Naples, Italy.
  • Claar E; Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy.
Biology (Basel) ; 11(6)2022 May 24.
Article in English | MEDLINE | ID: covidwho-1911165
ABSTRACT
People who use drugs (PWUDs) are generally considered "hard-to-treat" patients, due to adherence to HCV antiviral therapy or re-infection concerns. Linkage-to-care still remains a significant gap for HCV elimination, worsened by the COVID-19 pandemic. To reduce time-to-treat and improve treatment adherence, we have developed a patient-tailored model-of-care, decentralized within the addiction center and supervised remotely by hepatologists. From January 2017 to December 2020, patients were enrolled in one addiction care center in Southern Italy, where a complete hepatologic assessment, including blood chemistry, ultrasound, and transient elastography examination, was provided. DAAs treatment has been adapted on clinical features, also performing a daily administration during an outpatient visit, and monitored remotely by specialists via telemedicine interactions. Adherence was evaluated on the accomplishment of therapy or on the percentage of attended visits. From a total of 690 PWUDs, 135 had an active HCV infection and were enrolled in the study. All patients started the treatment within 3 weeks after HCV diagnosis. Six drop-outs were recorded, obtaining a sustained virological response at week 12 (SVR12) in 98.5% of PWUDs. There were only two cases of treatment failure, one of which is re-infection. No differences were found between the SVR12 rates before and during the COVID-19 pandemic. We obtained a high SVR12 rate, providing a comprehensive assessment within the addiction care center, tailoring the drug administration with a hepatologic remote stewardship. Our therapeutic model should improve the time-to-treat and treatment adherence in PWUDs.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study Language: English Year: 2022 Document Type: Article Affiliation country: Biology11060800

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study Language: English Year: 2022 Document Type: Article Affiliation country: Biology11060800