为吸毒者实施新的丙型肝炎病毒护理模式

IF 9.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
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引用次数: 0

摘要

背景& 目标据估计,全球有 5000 万人感染慢性丙型肝炎病毒(HCV),而吸毒者(PWUD)受到的影响尤为严重。持续的污名化和歧视使吸毒者(PWUD)难以获得医疗保健服务,这可能会阻碍在这一人群中消除丙型肝炎病毒(HCV)的进程。为了减少 PWUD 在获得医疗保健方面的障碍,我们开发了一种 HCV 护理模式,该模式简化了筛查和连接护理路径,并在西班牙巴利阿里群岛推广。该模式包括:(1) 通过护理点抗 HCV 检测、抽血或实验室记录进行参与者招募和现场 HCV 抗体筛查;(2) 通过干血斑或抽血进行 HCV RNA、HBsAg 和抗 HIV 检测;(3) 必要时通过远程医疗连接到专科护理和治疗处方;(4) 现场监测:(4) 现场监测:(a) 治疗结束后 4 周和≥12 周的持续病毒学应答(SVR);(b) 第 1 阶段或 SVR ≥12 次监测后 1 年的潜在新感染或再感染。结果在 2021 年 4 月至 2023 年 4 月期间,共招募了 1423 名参与者,其中 464 人(33%)为抗 HCV+,170 人(12%)可检测到 HCV RNA。后者中有 147 人(86%)开始接受治疗,其中 124 人(84%)完成了治疗。其中 95 人(77%)接受了 SVR ≥12 监测,88 人(93%)检测不到 HCV RNA。再次筛查时,发现了 4 例 HCV 再感染。超过 90% 的人接受参与研究,并接受分散筛查和治疗。结论这种经过调整的护理模式分散了筛查、诊断和治疗,有效地提高了吸毒者和非吸毒者中的医疗保健可及性,推动了西班牙在这一人群中消除 HCV 的进程。影响和意义:吸毒者和非吸毒者是全球受慢性丙型肝炎病毒(HCV)感染影响最严重的人群之一。西班牙巴利阿里群岛(Balearic Islands)的 21 个中心为这一人群实施了简化护理模式,在 2021-2023 年期间为 1423 名吸毒者提供丙型肝炎病毒护理。通过这种分散式筛查、诊断和治疗模式,在完成治疗并接受治疗后监测的患者中,丙型肝炎病毒治愈率达到 93%。巴利阿里群岛无丙型肝炎模式可为西班牙其他地区和世界其他地区的地区卫生当局和其他利益相关者消除丙型肝炎病毒的工作提供指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Implementing a new HCV model of care for people who use drugs

Implementing a new HCV model of care for people who use drugs

Background & Aims

An estimated 50 million individuals have chronic hepatitis C virus (HCV) infection worldwide and people who use drugs (PWUD) are disproportionately affected. Persistent stigma and discrimination make it challenging for PWUD to access healthcare, potentially hindering HCV elimination progress in this population. To mitigate healthcare access barriers in PWUD, an HCV care model that simplified screening and linkage to care pathways was developed and rolled out in the Balearic Islands, Spain.

Methods

The prospective multicentre community model of care was implemented in 21 centres serving PWUD. This model involved: (1) participant recruitment and HCV antibody screening onsite via a point-of-care anti-HCV test, phlebotomy, or laboratory records; (2) HCV RNA, HBsAg and anti-HIV testing via a dried blood spot or phlebotomy; (3) linkage to specialist care and treatment prescription via telemedicine, when required; and (4) onsite monitoring of: (a) sustained virologic response (SVR) 4 and ≥12 weeks after treatment completion and; (b) potential new HCV infection or reinfection ∼1 year after phase 1 or SVR ≥12 monitoring. Care model acceptability was assessed.

Results

Between April 2021 and April 2023, 1,423 participants were recruited, of whom 464 (33%) were anti-HCV+ and 170 (12%) had detectable HCV RNA. Of the latter, 147 (86%) initiated therapy, of whom 124 (84%) completed it. SVR ≥12 monitoring was performed in 95 (77%) of these, of whom 88 (93%) had undetectable HCV RNA. Upon re-screening, four HCV reinfections were detected. Over 90% accepted study participation and screening and treatment decentralisation.

Conclusions

This adapted care model, which decentralised screening, diagnosis, and treatment, effectively increased healthcare access among PWUD, improving progress towards HCV elimination in this population in Spain.

Impact and implications:

People who use drugs (PWUD) are among the most affected by chronic hepatitis C virus (HCV) infection globally. A simplified model of care was implemented in 21 centres serving this population across the Balearic Islands, Spain, to offer HCV care to 1,423 PWUD in 2021-2023. This decentralised screening, diagnosis, and treatment model resulted in an HCV cure rate of 93% of those who both completed therapy and were monitored post treatment completion. The Hepatitis C Free Balears model can guide the HCV elimination efforts of regional health authorities and other stakeholders in the rest of Spain and other parts of the world.

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来源期刊
JHEP Reports
JHEP Reports GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
12.40
自引率
2.40%
发文量
161
审稿时长
36 days
期刊介绍: JHEP Reports is an open access journal that is affiliated with the European Association for the Study of the Liver (EASL). It serves as a companion journal to the highly respected Journal of Hepatology. The primary objective of JHEP Reports is to publish original papers and reviews that contribute to the advancement of knowledge in the field of liver diseases. The journal covers a wide range of topics, including basic, translational, and clinical research. It also focuses on global issues in hepatology, with particular emphasis on areas such as clinical trials, novel diagnostics, precision medicine and therapeutics, cancer research, cellular and molecular studies, artificial intelligence, microbiome research, epidemiology, and cutting-edge technologies. In summary, JHEP Reports is dedicated to promoting scientific discoveries and innovations in liver diseases through the publication of high-quality research papers and reviews covering various aspects of hepatology.
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