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Research Article
Initiation of Hepatitis C treatment in two rural Rwandan districts: A mobile clinic approach
Innocent Kamali
Partners In Health/Inshuti Mu Buzima, Rwinkwavu
Corresponding Author
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Background: To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing hepatitis C patients with free access to Direct Acting Antivirals (DAAs). Until 2020, all prescribers trained and authorized to initiate DAA treatment were based at District Hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We designed and implemented a mobile hepatitis clinic to provide DAA treatment initiation at primary-level health facilities among hepatitis C patients identified through mass screening campaigns in rural Kirehe and Kayonza districts.
Methods: The mobile clinic team was composed of one clinician trained and authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care.
Results: Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with chronic hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD.
Conclusion: The mobile clinic model was a feasible strategy for providing rapid treatment initiation among hepatitis C patients identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-center level.
Keywords
Hepatitis C, Mobile clinic, Rural Health, Rwanda
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CURRENT STATUS: Under Revision
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Posted 18 Dec, 2020
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Editorial decision: Major revision
On 08 Jan, 2021
Review #3 received
Received 29 Dec, 2020
Review #2 received
Received 29 Dec, 2020
Review #1 received
Received 29 Dec, 2020
Review #4 received
Received 29 Dec, 2020
Reviewer #8 agreed
On 18 Dec, 2020
Reviewer #4 agreed
On 18 Dec, 2020
Reviewer #1 agreed
On 18 Dec, 2020
Reviewer #6 agreed
On 18 Dec, 2020
Reviewer #11 agreed
On 18 Dec, 2020
Reviewer #10 agreed
On 18 Dec, 2020
Reviewer #2 agreed
On 18 Dec, 2020
Reviewer #7 agreed
On 18 Dec, 2020
Reviewer #3 agreed
On 18 Dec, 2020
Reviewer #9 agreed
On 18 Dec, 2020
Reviewer #5 agreed
On 18 Dec, 2020
Reviewer #12 agreed
On 18 Dec, 2020
Reviewers invited
Invitations sent on 17 Dec, 2020
Editor assigned
On 17 Dec, 2020
Editor invited
On 17 Dec, 2020
Submission checks complete
On 17 Dec, 2020
First submitted
On 08 Dec, 2020
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Initiation of Hepatitis C treatment in two rural Rwandan districts: A mobile clinic approach
Innocent Kamali
Partners In Health/Inshuti Mu Buzima, Rwinkwavu
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 18 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 08 Jan, 2021
Review #3 received
Received 29 Dec, 2020
Review #2 received
Received 29 Dec, 2020
Review #1 received
Received 29 Dec, 2020
Review #4 received
Received 29 Dec, 2020
Reviewer #8 agreed
On 18 Dec, 2020
Reviewer #4 agreed
On 18 Dec, 2020
Reviewer #1 agreed
On 18 Dec, 2020
Reviewer #6 agreed
On 18 Dec, 2020
Reviewer #11 agreed
On 18 Dec, 2020
Reviewer #10 agreed
On 18 Dec, 2020
Reviewer #2 agreed
On 18 Dec, 2020
Reviewer #7 agreed
On 18 Dec, 2020
Reviewer #3 agreed
On 18 Dec, 2020
Reviewer #9 agreed
On 18 Dec, 2020
Reviewer #5 agreed
On 18 Dec, 2020
Reviewer #12 agreed
On 18 Dec, 2020
Reviewers invited
Invitations sent on 17 Dec, 2020
Editor assigned
On 17 Dec, 2020
Editor invited
On 17 Dec, 2020
Submission checks complete
On 17 Dec, 2020
First submitted
On 08 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing hepatitis C patients with free access to Direct Acting Antivirals (DAAs). Until 2020, all prescribers trained and authorized to initiate DAA treatment were based at District Hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We designed and implemented a mobile hepatitis clinic to provide DAA treatment initiation at primary-level health facilities among hepatitis C patients identified through mass screening campaigns in rural Kirehe and Kayonza districts.
Methods: The mobile clinic team was composed of one clinician trained and authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care.
Results: Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with chronic hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD.
Conclusion: The mobile clinic model was a feasible strategy for providing rapid treatment initiation among hepatitis C patients identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-center level.
Figure 1