University of Kentucky College of Medicine, Department of Behavioral Science, 845 Angliana Ave., Lexington, KY 40508, USA.
University of Kentucky College of Public Health, Department of Epidemiology, 111 Washington Avenue, Office 211C, Lexington, KY 40536, USA; University of Kentucky College of Medicine, Department of Behavioral Science, Center on Drug and Alcohol Research, 845 Angliana Ave., Lexington, KY 40508, USA.
Int J Drug Policy. 2017 Sep;47:86-94. doi: 10.1016/j.drugpo.2017.05.045. Epub 2017 Jun 23.
Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings.
503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis.
150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider.
While only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.
丙型肝炎病毒（HCV）仍然是全球发病率和死亡率的主要原因。自 2009 年以来，肯塔基州的急性 HCV 病例在美国各州中处于领先地位，这主要是由于农村地区的注射吸毒。改进的治疗方案有望减轻 HCV 的影响和传播，但许多障碍使注射吸毒者（PWID）无法获得治疗，特别是在医疗服务不足的环境中。
使用受访者驱动抽样法招募了 503 名农村吸毒者，并对其进行了 HCV 筛查和检测后咨询。使用干血斑酶免疫测定法评估 HCV 抗体的存在。使用基于计算机的问卷收集社会人口统计学和行为数据。使用离散时间生存分析确定 HCV 阳性血清检测和咨询后与医疗保健提供者联系的预测因素。
254 名参与者中有 150 名（59%）在 HCV 阳性血清检测和咨询后 18 个月内联系了医疗保健提供者；最高概率发生在血清检测后六个月内。35 名参与者（14%）报告正在寻求治疗，21 名（8%）报告正在接受治疗。在多变量时间依赖性模型中，医疗保险、互联网接入、既往物质使用治疗、符合 DSM-IV 广泛性焦虑障碍标准以及最近大麻使用增加了进行随访的可能性。符合重性抑郁障碍标准且报告既往美沙酮使用（无论是合法还是非法）的参与者不太可能联系提供者。
虽然只有 8%的人在 HCV 阳性筛查后接受了治疗，但在这个农村 PWID 样本中，联系医疗保健提供者的情况很频繁，这表明医疗保健的主要障碍可能更下游。这些发现提供了有关 HCV 医疗治疗级联的决定因素的见解，最终提供了治疗即预防。建议进一步研究并增加资源，以支持在其他环境中具有有效性的综合干预措施，以减轻资源匮乏环境中 HCV 的影响。
