Impact of a Simplified Care Model on Direct-acting Antiviral Treatment for Hepatitis C Virus-positive People in Addiction Care: A Retrospective Review of the trueNorth Medical Centres Database
Bibliographic record
Abstract
ABSTRACT Objectives: In people who use drugs registered with trueNorth Medical Centre, Ontario, Canada, the primary objective was to determine the proportions of those who initiated direct-acting antiviral (DAA) treatment for hepatitis C virus, as traditional care or simplified care. Methods: NORTHERN-HCV was a single-cohort, noninterventional, retrospective review (April 2013–November 2020), including 10 centres that implemented a simplified care model (January–September 2019). The study outcomes included the percentages of people for each step of the care cascade. The efficacy of the care model was assessed as the proportion of people who achieved sustained virologic response 12 weeks after treatment (SVR12). Results: A total of 1408 people were included in the study. As a primary outcome, 43.8% (92/210; 95% CI: 37.1%–50.5%) of treatment-eligible people initiated DAA treatment under the simplified care model. Ten percent (21/210; 95% CI: 5.9%–14.1%) of people initiated treatment under the traditional care model, 15.2% (32/210; 95% CI: 10.4%–20.1%) initiated treatment, but had no, or incomplete, data on their care model, and 31.0% (24.7%–37.2%) did not initiate treatment. Fifty-one percent (74/145; 95% CI: 42.9%–59.2%) and 11.0% (16/145; 95% CI: 5.9%–16.1%) completed treatment under the simplified and the traditional care models, respectively. SVR12 assessment was completed in 30.7% (35/114; 95% CI: 22.2%–39.2%) and 3.5% (4/114; 95% CI: 0.1%–6.9%) under the simplified and traditional care models, respectively. Conclusions: The simplified care model implemented in 10 trueNorth Medical Centres improved DAA treatment initiation with more people completing treatment and being assessed for SVR12. Objectifs: Chez les toxicomanes inscrits au Centre médical TrueNorth (TNMC), Ontario, Canada, l’objectif principal était de déterminer les proportions de ceux qui ont commencé un traitement antiviral à action directe (AAD) pour le virus de l’hépatite C (VHC), dans le cadre des soins traditionnels ou des soins simplifiés. Méthodes: NORTHERN-HCV était une étude rétrospective à cohorte unique et non interventionnelle (avril 2013 - novembre 2020), incluant 10 centres ayant mis en place un modèle de soins simplifiés (janvier - septembre 2019). Les résultats de l'étude comprenaient les pourcentages de personnes pour chaque étape de la cascade de soins. L’efficacité du modèle de soins a été évaluée en tant que proportion de personnes ayant obtenu une réponse virologique soutenue 12 semaines après le traitement (RVS12). Résultats: Au total, 1 408 personnes ont été incluses dans l'étude. Comme résultat principal, 43,8% (92/210; intervalle de confiance [IC] à 95%: 37,1%-50,5%) des personnes admissibles au traitement ont commencé un traitement ADD dans le cadre du modèle de soins simplifiés. Dix pour cent (21/210; IC à 95%: 5,9%-14,1%) des personnes ont entamé un traitement selon le modèle de soins traditionnels, 15,2% (32/210; IC à 95%: 10,4%-20,1%) ont entamé un traitement, mais n’avaient pas de données sur leur modèle de soins ou avaient des données incomplètes, et 31,0% (24,7%-37,2%) n’ont pas entamé de traitement. Cinquante et un pour cent (74/145; IC 95%: 42,9%-59,2%) et 11% (16/145; IC 95%: 5,9%-16,1%) ont terminé le traitement selon le modèle de soins simplifiés et le modèle de soins traditionnels, respectivement. L'évaluation de la RVS12 a été réalisée dans 30,7% (35/114 ; IC 95%: 22,2%-39,2%) et 3,5% (4/114; IC 95%: 0,1%-6,9%) dans le cadre des modèles de soins simplifiés et traditionnels, respectivement. Conclusions: Le modèle de soins simplifiés mis en œuvre dans 10 TNMC a amélioré l’initiation du traitement AAD avec plus de personnes terminant le traitement et étant évaluées pour la RVS12.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".