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Nurse-led initiation of hepatitis C care in rural Cambodia | Journal Article / Research | MSF Science Portal
Journal Article
|Research

Nurse-led initiation of hepatitis C care in rural Cambodia

O’Keefe D, Samley K, Bunreth V, Marquardt T, Bobi SE, Antharo K, San Kim C, Sothy H, Sokha T, Samnang C, Sokchea Y, Hossain FN, Balkan S, Le Paih M, Dousset JP
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Abstract
OBJECTIVE
To determine whether a nurse-led model of care for patients with hepatitis C virus (HCV) infections can provide safe and effective diagnosis and treatment in a resource-poor setting in rural Cambodia.

METHODS
The nurse-led initiation pilot project was implemented by Médecins Sans Frontières in collaboration with the Cambodian health ministry in two operational districts in Battambang Province between 1 June and 30 September 2020. Nursing staff at 27 rural health centres were trained to identify signs of decompensated liver cirrhosis and to provide HCV treatment. Patients without decompensated cirrhosis or another comorbidity were initiated at health centres onto combined treatment with sofosbuvir, 400 mg/day, and daclatasvir, 60 mg/day, orally for 12 weeks. Treatment adherence and effectiveness were assessed during follow-up.

FINDINGS
Of 10 960 individuals screened, 547 had HCV viraemia (i.e. viral load = 1000 IU/mL). Of the 547, 329 were eligible for treatment initiation at health centres through the pilot project. All 329 (100%) completed treatment and 310 (94%; 95% confidence interval: 91-96) achieved a sustained virological response 12 weeks post-treatment. Depending on patient subgroups, this response varied from 89% to 100%. Only two adverse events were recorded; both were determined as unrelated to treatment.

CONCLUSION
The safety and effectiveness of direct-acting antiviral medication has previously been demonstrated. Models of HCV care now need to enable greater access for patients. The nurse-led initiation pilot project provides a model for use in other resource-poor settings to scale up national programmes.

Countries

Cambodia

Subject Area

models of carehepatitis Cnursing

Collections

Nursing care at MSF

Languages

English
French
Spanish
Arabic
Chinese
Russian
DOI
10.2471/BLT.22.288956
Published Date
01 Apr 2023
PubMed ID
37008268
Journal
Bulletin of the World Health Organization
Volume | Issue | Pages
Volume 101, Issue 04, Pages 262-270
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