Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1.
Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, Canada J4K 0A8; Institut National de Santé Publique du Québec, 190 Crémazie E, Montréal, QC, Canada H2P 1E2.
Int J Drug Policy. 2015 Oct;26(10):970-5. doi: 10.1016/j.drugpo.2015.04.013. Epub 2015 Apr 25.
Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP).
A prospective cohort study, HEPCO, was conducted among active PWID in Montréal (2004-2013). Interviews scheduled at 3- or 6-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence.
At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0-21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% CI: 0.31-0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection.
Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention.
要降低注射毒品人群（PWID）中丙型肝炎病毒（HCV）的传播率，需要采取综合预防措施，包括提供减少伤害措施和医疗保健相关干预措施，如 HCV 筛查、检测和抗病毒治疗。然而，当将这些措施整合到综合预防方法中时，关于 PWID 就诊于初级保健医生（PCP）与 HCV 感染风险之间的关系，人们知之甚少。本研究评估了在参加针具交换计划（NEP）的 PWID 中，PCP 就诊与 HCV 血清转换之间的关系。
HEPCO 是一项在蒙特利尔进行的前瞻性队列研究，研究对象为活跃的 PWID（2004-2013 年）。每 3 或 6 个月安排一次访谈，包括完成访谈者管理的问卷，并采集 HCV 抗体检测的血样。在基线时报告参加 NEP 并至少有一次随访的 HCV 血清阴性参与者符合本研究条件。使用人时法计算 HCV 发病率。采用时变 Cox 回归模型评估近期 PCP 就诊与 HCV 发病率之间的关系。
在基线评估时，226 名参与者（80.5%为男性；中位年龄：30.6 岁）中有 37.2%报告最近就诊于 PCP。在 449.6 人年的随访期间，79 名参与者 HCV 血清转阳[发病率：17.6/100 人年，95%置信区间（CI）：14.0-21.8]。调整协变量后分析表明，就诊于 PCP 与 HCV 感染风险降低相关[调整后的危险比：0.54，95%CI：0.31-0.93]。HCV 感染的其他独立预测因素包括不稳定住房、可卡因注射和处方类阿片类药物注射。
在参加 NEP 的 PWID 中，就诊于 PCP 与 HCV 感染风险降低相关。然而，只有少数参与者报告就诊于 PCP。加强 PWID 与 PCP 的接触，可能会在整合到综合预防方法中时，有助于降低 HCV 的传播。
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