Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, UWMFCB 5th floor, Madison, WI 53705, USA.
Harm Reduct J. 2014 Jan 14;11:1. doi: 10.1186/1477-7517-11-1.
People who inject drugs (PWID) are at high risk of contracting and transmitting and hepatitis C virus (HCV). While accurate screening tests and effective treatment are increasingly available, prior research indicates that many PWID are unaware of their HCV status.
We examined characteristics associated with HCV screening among 553 PWID utilizing a free, multi-site syringe exchange program (SEP) in 7 cities throughout Wisconsin. All participants completed an 88-item, computerized survey assessing past experiences with HCV testing, HCV transmission risk behaviors, and drug use patterns. A subset of 362 clients responded to a series of open-ended questions eliciting their perceptions of barriers and facilitators to screening for HCV. Transcripts of these responses were analyzed qualitatively using thematic analysis.
Most respondents (88%) reported receiving a HCV test in the past, and most of these (74%) were tested during the preceding 12 months. Despite the availability of free HCV screening at the SEP, fewer than 20% of respondents had ever received a test at a syringe exchange site. Clients were more likely to receive HCV screening in the past year if they had a primary care provider, higher educational attainment, lived in a large metropolitan area, and a prior history of opioid overdose. Themes identified through qualitative analysis suggested important roles of access to medical care and prevention services, and nonjudgmental providers.
Our results suggest that drug-injecting individuals who reside in non-urban settings, who have poor access to primary care, or who have less education may encounter significant barriers to routine HCV screening. Expanded access to primary health care and prevention services, especially in non-urban areas, could address an unmet need for individuals at high risk for HCV.
注射毒品者（PWID）感染和传播丙型肝炎病毒（HCV）的风险很高。虽然越来越多的准确筛查试验和有效治疗方法可用，但先前的研究表明，许多 PWID 不知道自己的 HCV 状况。
我们利用威斯康星州 7 个城市的 7 个免费多站点注射器交换计划（SEP），检查了与 553 名 PWID 进行 HCV 筛查相关的特征。所有参与者都完成了一项 88 项的计算机调查，评估了他们过去 HCV 检测、HCV 传播风险行为和吸毒模式的经验。362 名客户对一系列开放式问题做出了回应，这些问题引出了他们对 HCV 筛查的障碍和促进因素的看法。这些回应的记录使用主题分析进行了定性分析。
大多数受访者（88%）报告过去接受过 HCV 检测，其中大多数（74%）是在过去 12 个月内接受检测的。尽管 SEP 提供免费的 HCV 筛查，但不到 20%的受访者曾在注射器交换点接受过 HCV 检测。如果客户有初级保健提供者、更高的教育程度、居住在大都市区并且有过阿片类药物过量的病史，他们在过去一年中更有可能接受 HCV 筛查。通过定性分析确定的主题表明医疗保健和预防服务的获取以及非评判性提供者的重要作用。
我们的研究结果表明，居住在非城市地区、难以获得初级保健或教育程度较低的吸毒者可能会在常规 HCV 筛查方面遇到重大障碍。扩大获得初级保健和预防服务的机会，特别是在非城市地区，可能会满足 HCV 高风险人群的未满足需求。
