Tennant Elaine, Vollmer-Conna Ute, Demirkol Apo, Post Jeffrey J
Healthy Homes and Neighbourhoods Team, Community Health, Sydney Local Health District, Sydney, New South Wales, Australia.
Infectious Diseases Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2017 Aug;47(8):907-914. doi: 10.1111/imj.13497.
Diagnosing blood-borne virus (BBV) infection is an essential first step in eliminating transmission and securing access to treatment amongst substance misusers.
To determine the proportion of substance misusers presenting to hospital who undergo BBV testing and the factors influencing testing.
A retrospective cross-sectional study was performed of patients presenting to two Sydney teaching hospitals with substance misuse diagnoses between January and April 2015. Proportions tested for human immunodeficiency virus, hepatitis C and hepatitis B previously and during the index hospitalisation presentation were examined. Multivariable analysis was performed to determine factors associated with testing.
Of 239 patients, 47 (19.7%) had a documented BBV at baseline. Of those with unknown BBV status, 29 (12.8%) had undergone some attempt at testing during presentation; 3.1% had their hepatitis B immunity assessed. Factors associated with an increased likelihood of testing during presentation included documented injecting drug use (odds ratio (OR) 15.14; 95% confidence interval (CI) 4.21-54.50; P < 0.001), admission under a physician (OR 11.79; 95% CI 2.82-49.40; P = 0.001) and admission on a Friday (OR 4.46; 95% CI 1.28-15.48; P = 0.02). Patients who had had more than one previous admission in the preceding 6 months (OR 0.24; 95% CI 0.078-0.73; P = 0.01) or a length of stay of 1 day or less (OR 0.17; 95% CI 0.032-0.87; P = 0.033) were less likely to be tested.
Despite the high baseline prevalence of BBV infections in the population, there were many missed opportunities for BBV testing. We found patient-, admission- and clinician-level barriers that could be addressed to enhance BBV testing uptake.
诊断血源性病原体（BBV）感染是杜绝传播并确保药物滥用者获得治疗的关键第一步。
确定前往医院就诊的药物滥用者中接受BBV检测的比例以及影响检测的因素。
对2015年1月至4月间前往悉尼两家教学医院就诊且被诊断为药物滥用的患者进行回顾性横断面研究。检查了此前及本次住院期间进行人类免疫缺陷病毒、丙型肝炎和乙型肝炎检测的比例。进行多变量分析以确定与检测相关的因素。
在239名患者中，47名（19.7%）在基线时有记录的BBV感染。在BBV状态未知的患者中，29名（12.8%）在就诊期间曾尝试进行检测；3.1%的患者评估了乙肝免疫力。就诊期间检测可能性增加的相关因素包括记录在案的注射吸毒史（比值比（OR）15.14；95%置信区间（CI）4.21 - 54.50；P < 0.001）、由内科医生收治（OR 11.79；95% CI 2.82 - 49.40；P = 0.001）以及周五入院（OR 4.46；95% CI 1.28 - 15.48；P = 0.02）。在过去6个月内有不止一次既往住院史的患者（OR 0.24；95% CI 0.078 - 0.73；P = 0.01）或住院时间为1天或更短的患者（OR 0.17；95% CI 0.032 - 0.87；P = 0.033）接受检测的可能性较小。
尽管该人群中BBV感染的基线患病率较高，但仍有许多错过的BBV检测机会。我们发现了患者、入院和临床医生层面的障碍，可加以解决以提高BBV检测的接受度。
