Place of therapeutic patient education in chronic hepatitis C treated with direct-acting antivirals

Place of therapeutic patient education in chronic hepatitis C treated with direct-acting antivirals

Michel Doffoel1*, Simona Tripon1, Florence Ernwein1, Frédéric Chaffraix1, Lucile Haumesser2, Robert Bader3, Jean-Philippe Lang1, Anais Lang1, Dominique Paya4, Maude Royant1, Aurélie Velay-Rusch5, Martine Tebacher6, Nicolas Meyer2, François Habersetzer7, Thomas Baumert8

1Service expert de lutte contre les hépatites virales d’alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires, Strasbourg, France. 2Groupe méthode en recherche clinique, Pôle de santé publique au travail, Hôpitaux universitaires, Strasbourg, France. 3Service d’hépato gastroentérologie, Groupement hospitalier régional mulhouse sud alsace, Mulhouse, France. 4Pharmacie, Hôpitaux universitaires, Strasbourg, France. 5Laboratoire de Virologie, Hôpitaux universitaires, Strasbourg, France. 6Centre régional de pharmacovigilance, Hôpitaux universitaires, Strasbourg, France. 7Service d’hépato gastroentérologie, Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires, Strasbourg, France. 8Institut de recherche sur maladies virales et hépatiques, Inserm U1110, Université de Strasbourg, Strasbourg, France.

Objective: Today, with the availability of direct-acting antivirals (DAAs), the value of therapeutic patient education (TPE) in chronic hepatitis C needs to be redefined, as these drugs have made treatment simple. The study presented here in sought to define what role TPE plays today in hepatitis C management along with what factors are associated with such programs being used.

Methods: We included 786 patients mono-infected with hepatitis C virus (HCV) who underwent treatment with DAAs. 284 of whom benefited from a TPE program (36.1%). The characteristics of HCV and how it was treated were compared retrospectively between TPE+ and TPE- patients. The TPE program was overseen by a nurse.

Results: The following factors were associated with TPE on multivariate analysis: migrant status (OR=3.63, 95%CI: 2.24-5.96, p <0.001), advanced fibrosis (OR=1.73, 95%CI: 1.08-2.76, p=0.022), tobacco use (OR=1.84, 95%CI: 1.10-3.08, p=0.020) and pangenotypic DAA treatment (OR=0.42, 95%CI: 0.26-0.68, p <0.001). Sustained virological response at 12 weeks (SVR 12) was 96% in both groups.

Conclusion: Overall, TPE was primarily followed by migrants during their HCV management as part of overall medico-psycho-social care, and primarily those with severe disease.

Practice implication: TPE could help reduce the impact of social inequality on health.


  • TPE in chronic hepatitis C treated with direct-acting antivirals need to be redefined.
  • The characteristics of chronic hepatitis C and how it is treated are compared between TPE+ and TPE- patients.
  • Migrant status, hepatic advanced fibrosis, tobacco use and pangenotypic direct-acting antivirals are associated with TPE.
  • Sustained virological response is high and do not differ between the 2 groups.

Keywords: hepatitis C, therapeutic patient education, direct-acting antivirals, migrants, advanced fibrosis, tobacco consumption

Free Full-text PDF

How to cite this article:
Michel Doffoel, Simona Tripon, Florence Ernwein, Frédéric Chaffraix, Lucile Haumesser, Robert Bader, Jean-Philippe Lang, Anais Lang, Dominique Paya, Maude Royant, Aurélie Velay-Rusch, Martine Tebacher, Nicolas Meyer, François Habersetzer, Thomas Baumert.Place of therapeutic patient education in chronic hepatitis C treated with direct-acting antivirals.Open Journal of Gastroenterology and Hepatology, 2022, 5:60. DOI: 10.28933/ojgh-2021-11-2607


1. World Health Organization. Regional Office for Europe. (‎1998)‎. Therapeutic patient education : continuing education programmes for health care providers in the field of prevention of chronic diseases : report of a WHO working group. Co-penhagen : WHO Regional Office for Europe.
2. [Therapeutic education of the patient. Law n ° 2009-879 of July 21, 2009 reforming the hospital and relating to patients, health and territories]. Art.L.1161-1. art. 84.
3. Cacoub P, Ouzan D, Melin P, Lang JP, Rotily M, Fontanges T, et al. Patient education improves adherence to peg-interferon and ribavirin in chronic genotype 2 or 3 hepatitis virus infection: a prospective, real-life, observational study. World J Gastroenterol 2008 ; 14 : 6195-203.
a. 10.3748/wjg.14.6195
4. Leclerc JB, Conort O, Bacq Y, Antier P. [Impact of a therapeutic education program on the knowledge, compliance and satisfaction of pa-tients treated for chronic viral hepatitis C. ] Educ Ther Patient 2011 ; 3 : 21-33.
5. Larrey D, Salsé A, Ribard D, Boutet O, Hy-railles-Blanc V, Niang B, et al. Education by a nurse increases response of patients with chronic hepatitis C to therapy with peginterferon-alfa2a and ribavirin. Clin Gastroenterol Hepatol 2011 ; 9 : 781-5.
6. [Letter of instruction relating to the organization of the management of hepatitis C with new direct anti-virals (NAAD) of December 28, 2014]. 5p.
7. [Instruction N ° DGOS / PF2 / DGS / SP2 / PP2 / DSS / 1C / 2016/246 of July 28, 2016 relating to the organization of the management of hepatitis C by the new anti-virals of action direct (NAAD).]
8. [Instruction N ° DGOS / PF2 / DGS / SP2 / DSS / 1C / 2017/246 of 3 August 2017 relating to the expansion of health insurance coverage for the treatment of hepatitis C by new agents di-rect-acting anti-virals (DAAs) at all stages of hepatic fibrosis for the indications provided for in the marketing authorization and to the limitation of holding a multidisciplinary consultation meeting for initiating treatment with specific situations listed.]
9. [HAS recommendations: Hepatitis C: simplified management in adults, 2019.]
10. [AFEF recommendations on the management of viral hepatitis C, January 2015, February 2016, March 2017 and February 2019.]
11. [SPC sheet for viral hepatitis C. July 2017. AFEF recommendations]
12. Jauffret-Roustide M, Pillonel J, Weill-Barillet L, Léon L, Le Strat Y, Brunet S, et al. [Estimation of the seroprevalence of HIV and hepatitis C among drug users in France. First results of the survey ANRS-Coquelicot 2011]. Bull Epidémiol Hebd. 2013 ;(39-40) : 504-9.
13. Drinking guidelines: General population. Interna-tional Alliance for Responsable Drinking (IARD); 2019.
14. European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C. Final update of the series.
15. [Therapeutic patient education in the manage-ment of hepatitis B and C. In: Management of persons infected with hepatitis B or hepatitis C viruses. 2014 recommendations report]. EKD/Groupe EDP Sciences Ed, Paris, 2014, p 359-79.
16. [Ministry of Health. Use and advisability of using professional interpreting in the health field]. December 2012, 139 p.
17. Adate, Aptira, Asamla, Cofrimi, Ism corum, Ism interprétariat, Ism, Mana, Migrations Santé Al-sace, Réseau ville hôpital 35. [Charter of medical and social interpreting in France, adopted in Strasbourg on December 14, 2012,] 12p.
18. Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C. J Hepatol 2001; 34 :730-9.
19. Pessione F, Ramond MJ, Njapoum C, Duchatelle V, Degott C, Erlinger S et al. Cigarette smoking and hepatic lesions in patients with chronic hepa-titis C. Hepatology 2001; 34 :121-5.
20. Dev A, Patel K, Conrad A, Blatt LM, McHutchison JG. Relationship of smoking and fibrosis in pa-tients with chronic hepatitis C. Clin Gastroenterol Hepatol 2006; 4 :797-801.
21. World Drug Report. ONUDC 2016.

Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details)

CC BY 4.0
This work and its PDF file(s) are licensed under a Creative Commons Attribution 4.0 International License.