Telemedicine and decentralized hepatitis C treatment as a strategy to enhance retention in care among people attending drug treatment centres.

BACKGROUND: People attending drug treatment centres have a high burden of hepatitis C virus (HCV) and face barriers to diagnosis and treatment. Dried blood spot (DBS) testing has been proposed to simplify diagnosis, but many patients remain untreated. In this retrospective study, we evaluated the reasons for non-retention in care in an intervention using on-site DBS testing and the effect of telemedicine and decentralized care compared to standard of care among people attending drug treatment centres who were lost to follow-up. METHODS: In a first phase, retention in care, adherence to treatment, and predictive factors in the DBS testing program of patients in drug treatment centres were analyzed and compared to a cohort of patients treated at the hospital outpatient clinic. Subsequently, in a second phase we evaluated in patients lost to follow-up from drug treatment centres the efficacy of one-step testing and telemedicine linked to a decentralized dispensation of HCV treatment or standard of care. RESULTS: Among 512 patients attending drug treatment centres, 467 (91.2%) agreed to be tested and 53.4% (237 patients/444 valid tests) tested positive (46 ± 9 years, 87.3% male) for HCV antibodies. After excluding patients negative for RNA or under surveillance, 178 patients were scheduled to meet with a specialist. Overall, 44 patients did not attend and 25 did not complete the pre-treatment evaluation. The only factor associated with retention in care was patient's knowledge of HCV infection. Treated patients attending drug treatment centres (n = 68) compared to the hospital outpatient clinic cohort (n = 135) had lower rates of treatment adherence. Among the patients who attended drug treatment centres that were lost to follow-up (n = 69), the proportion of patients who completed the program was significantly higher among those assisted by telemedicine than by standard of care (62.5% vs. 24.3%, p = 0.002). CONCLUSION: Although there was a high participation rate in a DBS testing program in drug treatment centres, non-retention in care is a challenge. Importantly, telemedicine linked to a decentralized dispensation of HCV treatment re-engages patients and may be effective for HCV microelimination.

Relationship between subsinus bone height and bone volume requirements for dental implants: a human radiographic study.

PURPOSE: To analyze the vertical dimension of subsinus alveolar bone that is available for placement of endosseous implants. MATERIALS AND METHODS: Subsinus alveolar bone height (SBH) was determined via radiographs and categorized into three groups: Group A corresponded to SBH < 5 mm; group B SBH of 5 to 9 mm; and group C, SBH > 9 mm. Statistical analysis was carried out using the Wilcoxon paired test with the threshold for statistical significance set at P < .05. RESULTS: Five hundred eighty-three panoramic radiographs of edentulous maxillae were analyzed. In 96.9% of radiographs, the anterior border of the maxillary sinus was above the first premolar. Mean SBH values for canine, first premolar, second premolar, first molar, and second molar sites were 11.4 ± 6.2 mm, 10.6 ± 3.8 mm, 5.9 ± 2.5 mm, 3.3 ± 2.2 mm, and 4.5 ± 2.4 mm, respectively. Representations of groups A, B, and C in the canine region were 14.3%, 21.4%, and 64.3%, respectively; in the first premolar region they were 8.3%, 22.3%, and 69.4%, respectively; in the second premolar region, these were 31.6%, 60.9%, and 7.5%, respectively; in first molar region, the values were 73.1%, 25.4%, and 1.5%, respectively; and in the second molar region they were 54.2%, 41.7%, and 4.1%, respectively. CONCLUSIONS: The mean SBH is the highest in the area of the anterior border of the sinus; it declines significantly toward the posterior maxilla, reaches its minimum in the area of the first molar, and increases again significantly in the second molar region. From a clinical point of view, the lateral window technique of sinus elevation remains the dominant augmentative procedure in the molar area, whereas in the premolar area, less invasive alternative methods may be more appropriate.