Enhanced Access to Testing & Diagnosis & Hepatitis C Burden; A Public Health Intervention

Abstract

Objective: To gauge the effect of increasing access to care and streamlining testing and diagnosis on hepatitis C burden (incidence of disease, rate (%) of complications, adverse events and mortality) in a rural population. Methodology: This quasi-experimental research was conducted at Taluka Gambat (Khairpur, Sindh, Pakistan) from August 2019 to January 2021. This public health intervention, comprised of establishing collection points, near healthcare centers in Gambat Taluka, that facilitated the sample collection, transport and testing of patient samples (for Hep C). The test results along with basic biodata, sociodemographic details, disease particulars, presenting signs and symptoms (and their duration), of consenting patients, were recorded onto a structured questionnaire and the data analyzed using SPSS. v. 21.0. Results:  A total of 492 individuals were studied. The mean age of the sample was 32.5± 6.9 years with an age range of 18 to 65 years. Pre-Intervention (establishment of collection units) records showcased a lower frequency of cases being reported, which jumped to more than three-fold following provision of greater access to testing and diagnosis. The number of cases presenting with Hep C complications though, steadily declined (from 66.7% to 12.1% - p: < 0.05), and the mortality rate took a significant dive (33.3% to 0% - p: < 0.05). The incidence of diagnosed cases presenting with adverse outcomes (liver cirrhosis, liver failure and hepatic carcinoma) fell sharply, from 33% to 6.1% - p: < 0.05. Conclusion: Enhanced access to care and streamlining testing and diagnosis, overtime reduced the disease burden associated with Hepatitis C, by identifying patients with the disease early before the disease progresses and leads to adverse events.