作为 HIV 预防增强措施的丙型肝炎筛查（SHAPE）：马萨诸塞州一个县惩教设施的整合试点倡议。
Screening for Hepatitis C as a Prevention Enhancement (SHAPE) for HIV: an integration pilot initiative in a Massachusetts County correctional facility.
机构信息
Massachusetts Department of Public Health, Bureau of Infectious Disease, Jamaica Plain, MA.
Barnstable County Sheriff's Department, Bourne, MA.
出版信息
Public Health Rep. 2014 Jan-Feb;129 Suppl 1(Suppl 1):5-11. doi: 10.1177/00333549141291S102.
OBJECTIVES
The Massachusetts Department of Public Health (MDPH) and the Barnstable County Sheriff's Department (BCSD) in Massachusetts initiated a pilot program in July 2009 offering education and hepatitis C virus (HCV) antibody testing to inmates and detainees, concurrent with routine HIV testing. The initiative was implemented to assess the feasibility of integrating HCV screening into an HIV screening program in a correctional setting and the efficacy of linking HCV antibody-positive inmates to clinical care upon release.
METHODS
Through the Screening for Hepatitis C as a Prevention Enhancement initiative, HCV and HIV testing were offered to inmates and detainees shortly after admission, and by request at any time during incarceration. In preparation for release, referrals were made to community-based medical providers for HCV follow-up care. Data from BCSD were compared with routine surveillance data received by MDPH. Confirmatory HCV test results received by April 15, 2012, were considered indicators of appropriate post-release clinical care.
RESULTS
From July 2009 through December 2011, 22% (n=596) and 25% (n=667) of 2,716 inmates/detainees accepted HCV and HIV testing, respectively. Of those tested for HCV antibody, 20.5% (n=122) were positive. Of those tested for HIV antibody, 0.8% (n=5) were positive. Of the inmates who tested HCV positive at BCSD and had been released, 37.8% were identified as receiving post-release medical care.
CONCLUSIONS
We determined that integration of HCV education and screening into correctional facilities is feasible and reveals high rates of HCV infection. Although this model presupposes programmatic infrastructure, elements of the service design and integration could inform a range of correctional programs. Effective linkage to care, while substantial, was not routine based on our analysis, and may require additional resources given its cost and complexity.
目的
马萨诸塞州公共卫生部（MDPH）和巴恩斯特布尔县警长办公室（BCSD）于 2009 年 7 月启动了一项试点计划，为囚犯和被拘留者提供教育和丙型肝炎病毒（HCV）抗体检测，同时进行常规 HIV 检测。该倡议旨在评估在惩教环境中整合 HCV 筛查到 HIV 筛查计划的可行性，以及在释放时将 HCV 抗体阳性的囚犯与临床护理联系起来的效果。
方法
通过 HCV 筛查作为预防增强倡议，在囚犯和被拘留者入院后不久，以及在服刑期间的任何时间，根据请求提供 HCV 和 HIV 检测。在准备释放时，向基于社区的医疗提供者转介 HCV 随访护理。BCSD 的数据与 MDPH 收到的常规监测数据进行了比较。截至 2012 年 4 月 15 日收到的 HCV 确认检测结果被视为适当的释放后临床护理的指标。
结果
从 2009 年 7 月至 2011 年 12 月，22%（n=596）和 25%（n=667）的 2716 名囚犯/被拘留者分别接受了 HCV 和 HIV 检测。在接受 HCV 抗体检测的人中，20.5%（n=122）呈阳性。在接受 HIV 抗体检测的人中，0.8%（n=5）呈阳性。在 BCSD 检测 HCV 呈阳性并已获释的囚犯中，37.8%被确定为接受释放后的医疗护理。
结论
我们确定将 HCV 教育和筛查纳入惩教设施是可行的，并揭示了 HCV 感染的高发病率。尽管这种模式假设了计划的基础设施，但服务设计和整合的要素可以为一系列惩教计划提供信息。根据我们的分析，有效的联系到护理虽然很大，但不是常规的，鉴于其成本和复杂性，可能需要额外的资源。
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