From risk to care: the hepatitis C screening and diagnostic cascade in a primary health care clinic in Karachi, Pakistan—a cohort study. Issue 1 (28th December 2018)

• Record Type: Journal Article
• Authors: Khalid, Gul Ghuttai; Kyaw, Khine Wut Yee; Bousquet, Christine; Auat, Rosa; Donchuk, Dmytro; Trickey, Adam; Hamid, Saeed; Qureshi, Huma; Mazzeo, Valentina; Aslam, Khawar; Khowaja, Salima; Van den Bergh, Rafael
• Is Part Of: International health. Volume 12:Issue 1(2020)
• Page Start: 19
• Page End: 27
• Publication Date: 2018-12-28
• Subjects: hepatitis C -- operational research -- risk factors -- SORT IT -- testing and treatment algorithm -- time delays; World health -- Periodicals; Public health -- Developing countries -- Periodicals; Medical care -- Developing countries -- Periodicals; Medical policy -- Developing countries -- Periodicals; 362.1091724
• DOI: 10.1093/inthealth/ihy096
• Languages: English
• ISSNs: 1876-3413

Abstract

Abstract: Background: In the high-prevalence setting of Pakistan, screening, diagnosis and treatment services for chronic hepatitis C (CHC) patients are commonly offered in specialized facilities. We aimed to describe the cascade of care in a Médecins Sans Frontières primary health care clinic offering CHC care in an informal settlement in Karachi, Pakistan. Methods: This was a retrospective cohort analysis using routinely collected data. Three different screening algorithms were assessed among patients with one or more CHC risk factors. Results: Among the 87 348 patients attending the outpatient clinic, 5003 (6%) presented with one or more risk factors. Rapid diagnostic test (RDT) positivity was 38% overall. Approximately 60% of the CHC patients across all risk categories were in the early stage of the disease, with an aspartate aminotransferase:platelet ratio index score <1. The sequential delays in the cascade differed between the three groups, with the interval between screening and treatment initiation being the shortest in the cohort tested with GeneXpert onsite. Conclusions: Delays between screening and treatment can be reduced by putting in place more patient-centric testing algorithms. New strategies, to better identify and treat the hidden at-risk populations, should be developed and implemented.