Division of General Internal Medicine and Hepatology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
J Viral Hepat. 2012 Jan;19(1):47-54. doi: 10.1111/j.1365-2893.2010.01411.x. Epub 2010 Dec 3.
Despite a high prevalence of hepatitis C virus (HCV) among drug users, HCV evaluation and treatment acceptance are extremely low among these patients when referred from drug treatment facilities for HCV management. We sought to increase HCV treatment effectiveness among patients from a methadone maintenance treatment program (MMTP) by maintaining continuity of care. We developed, instituted and retrospectively assessed the effectiveness of an integrated, co-localized care model in which an internist-addiction medicine specialist from MMTP was embedded in the hepatitis clinic. Methadone maintenance treatment program patients were referred, evaluated by the internist and hepatologist in hepatitis clinic and provided HCV treatment with integration between both sites. Of 401 evaluated patients, anti-HCV antibody was detected in 257, 86% of whom were older than 40 years. Hepatitis C virus RNA levels were measured in 222 patients, 65 of whom were aviremic. Of 157 patients with detectable HCV RNA, 125 were eligible for referral to the hepatitis clinic, 76 (61%) of whom accepted and adhered with the referral. Men engaged in MMTP <36 months were significantly less likely to be seen in hepatitis clinic than men in MMTP more than 36 months (odds ratio = 7.7; 95% confidence interval 2.6-22.9) or women. We evaluated liver histology in 63 patients, and 83% had moderate to advanced liver disease. Twenty-four patients initiated treatment with 19 completing and 13 (54%) achieving sustained response. In conclusion, integrated care between the MMTP and the hepatitis clinic improves adherence with HCV evaluation and treatment compared to standard referral practices.
尽管吸毒者中丙型肝炎病毒 (HCV) 的流行率很高，但当这些患者从戒毒治疗机构转介到 HCV 管理机构时，他们接受 HCV 评估和治疗的意愿极低。我们试图通过保持治疗的连续性来提高美沙酮维持治疗计划 (MMTP) 患者的 HCV 治疗效果。我们开发了一种综合、本地化的护理模式，并在丙型肝炎诊所中引入了一位来自 MMTP 的内科医生-药物滥用专家，以评估其在该模式中的有效性。MMTP 患者被转介到丙型肝炎诊所，由内科医生和肝病专家进行评估，并在两个地点之间整合提供 HCV 治疗。在评估的 401 名患者中，257 名患者抗-HCV 抗体检测呈阳性，其中 86%的患者年龄大于 40 岁。222 名患者的 HCV RNA 水平得到了测量，其中 65 名患者病毒血症。在 157 名可检测到 HCV RNA 的患者中，125 名有资格被转介到肝炎诊所，其中 76 名（61%）接受并坚持转介。参与 MMTP 时间<36 个月的男性与参与 MMTP 时间超过 36 个月的男性（比值比=7.7；95%置信区间 2.6-22.9）或女性相比，更不可能在肝炎诊所就诊。我们对 63 名患者进行了肝组织学评估，其中 83%的患者存在中重度肝疾病。24 名患者开始接受治疗，其中 19 名完成治疗，13 名（54%）获得持续应答。总之，与标准转介实践相比，MMTP 和肝炎诊所之间的综合护理可提高 HCV 评估和治疗的依从性。
