Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, UK.
J Public Health (Oxf). 2012 Mar;34(1):14-23. doi: 10.1093/pubmed/fdr097. Epub 2011 Dec 2.
In Scotland, a general practice-based case-finding initiative, to diagnose and refer hepatitis C virus (HCV) chronically infected former injecting drug users (IDUs), was evaluated.
Testing was offered in eight Glasgow general practices in areas of high deprivation and high HCV and IDU prevalence to attendees aged 30-54 years with a history of IDU. Test uptake and diagnosis rates were compared with those in eight demographically similar control practices.
Of 422 eligible intervention practice attendees, 218 (52%) were offered an HCV test and, of these, 121 (56%) accepted. Poor venous access in 13 individuals prevented testing. Of 105 tested, 70% (74/105) were antibody positive of which 58% (43/74) were RNA positive by PCR. Of 43 chronically infected individuals identified in intervention practices, 22 (51%) had attended specialist care within 30 months of the study, while 9 (21%) had defaulted. In control practices, 8 (22%) of 36 individuals tested were antibody positive. Test uptake and case yield were approximately 3 and 10 times higher in intervention compared with control practices, respectively.
Targeted case-finding in primary care demonstrated higher test uptake and diagnosis rates; however, to optimize diagnosis and referral of chronically infected individuals, alternative means of testing (e.g. dried blood spots) and retention in specialist care (e.g. outreach services) must be explored.
在苏格兰，开展了一项基于全科医生的病例发现计划，旨在诊断和转介慢性感染丙型肝炎病毒（HCV）的前注射吸毒者（IDU）。
在 8 家位于贫困和 HCV 及 IDU 流行率较高地区的格拉斯哥全科医生诊所，向年龄在 30-54 岁、有 IDU 史的就诊者提供检测。比较了检测的参与率和诊断率与 8 家在人口统计学上相似的对照诊所的情况。
在 422 名符合条件的干预实践就诊者中，218 名（52%）被提供了 HCV 检测，其中 121 名（56%）接受了检测。13 人静脉穿刺困难，无法进行检测。在 105 名接受检测者中，70%（74/105）抗体阳性，其中 58%（43/74）PCR 检测 RNA 阳性。在干预实践中确定的 43 名慢性感染个体中，22 名（51%）在研究后 30 个月内接受了专科治疗，而 9 名（21%）失访。在对照诊所中，36 名接受检测者中有 8 名（22%）抗体阳性。与对照实践相比，干预实践的检测参与率和病例检出率分别高出约 3 倍和 10 倍。
在初级保健中进行有针对性的病例发现可提高检测参与率和诊断率；然而，为了优化慢性感染个体的诊断和转介，必须探索替代检测方法（如干血斑）和保持在专科治疗中的联系（如外展服务）。
