1. Implementation of a unique hepatitis C care continuum model in Rwanda.
- Author
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Mathur P, Comstock E, Makuza JD, Emmanuel B, Sebeza J, Kiromera A, Wilson E, Kattakuzhy S, Nelson A, Kottilil S, and Riedel DJ
- Subjects
- Antiviral Agents therapeutic use, Education organization & administration, Female, Humans, Male, Models, Organizational, Program Development, Rwanda, Continuity of Patient Care organization & administration, Hepatitis C, Chronic drug therapy
- Abstract
Background: There has been an evolution in the treatment of chronic hepatitis C (HCV) due to highly effective direct-acting antivirals, however, restriction of treatment to medical specialists hinders escalation of HCV treatment. This is particularly true in resource-limited settings (RLS), which disproportionately represent the burden of HCV worldwide. The ASCEND study in Washington, DC, demonstrated that complete task-shifting can safely and effectively overcome a low provider-to-patient ratio and expand HCV treatment. However, this model has not been applied internationally to RLS., Method: The validated ASCEND model was translated to an international clinical program in Kigali, Rwanda, aimed at training general medicine providers on HCV management and obtaining HCV prevalence data., Results: The didactic training program administered to 11 new HCV providers in Rwanda increased provider's knowledge about HCV management. Through the training program, 26% of patients seen during the follow-up period were screened for HCV and a prevalence estimate of 2% was ascertained. Of these patients, 30% were co-infected with hepatitis B., Conclusion: The ASCEND paradigm can be successfully implemented in RLS to escalate HCV care, in a self-sustaining fashion that educates more providers about HCV management, while increasing the public's awareness of HCV and access to treatment., (© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2019
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