在一般医疗环境中检测丙型肝炎:澳大利亚注射吸毒者的横断面研究。
Hepatitis C testing in general practice settings: A cross-sectional study of people who inject drugs in Australia.
机构信息
National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, 2052, Australia.
The University of Sydney, New South Wales, 2006, Australia.
出版信息
Int J Drug Policy. 2017 Sep;47:102-106. doi: 10.1016/j.drugpo.2017.07.008. Epub 2017 Aug 5.
BACKGROUND
People who inject drugs (PWID) often do not receive confirmatory RNA testing following positive HCV antibody testing. Expanding access to adequate testing and assessment will improve the progression of patients through the HCV care cascade with the potential to improve diagnosis as well as linkage to treatment. We aimed to determine current utilisation of general practitioners (GPs) by PWID in Australia compared to other settings for HCV testing and post-test discussions.
METHODS
A national sample (n=888) of people who had injected drugs regularly in the past 6 months was interviewed about HCV antibody, RNA testing, and post-test discussions, and the settings where these took place.
RESULTS
The majority of participants (n=735; 93%) reported antibody testing. Among participants who reported a positive result (n=435), 54% identified their regular GP as the setting where their most recent antibody test was conducted. Confirmatory RNA testing was reported by 60% (n=274) of those who reported being antibody positive. Among those who reported RNA testing (n=257), the most common setting reported was their regular GP (48%). There were no differences in the proportions who recalled post-test discussions at GPs compared to other settings.
CONCLUSION
HCV testing was most frequently undertaken by participants' regular GP. GPs are currently providing testing and post-test discussions at similar proportions to other more specialised settings. However, RNA testing is incomplete for more than one-third of the antibody positive PWID interviewed. Our findings suggest that the general practice setting is a common and accessible setting for PWID to access HCV testing. Targeting GPs to improve follow-up of positive antibody tests may help to improve patient progression through the HCV care cascade.
背景
经常注射毒品的人(PWID)在 HCV 抗体检测呈阳性后,通常不会接受确认性 RNA 检测。扩大充分检测和评估的机会将改善患者通过 HCV 护理级联的进展,从而有可能改善诊断以及与治疗的联系。我们旨在确定澳大利亚 PWID 与其他环境相比,目前对 HCV 检测和检测后讨论的普通医生(GP)的利用情况。
方法
对过去 6 个月内定期注射毒品的 888 名人群进行了全国性抽样调查,内容包括 HCV 抗体、RNA 检测和检测后讨论,以及这些检测的进行场所。
结果
大多数参与者(n=735;93%)报告了抗体检测。在报告阳性结果的参与者中(n=435),54%的人将他们的常规 GP 确定为进行最近一次抗体检测的场所。报告抗体阳性的参与者中,有 60%(n=274)报告了确认性 RNA 检测。在报告 RNA 检测的参与者中(n=257),报告最多的常见场所是他们的常规 GP(48%)。与其他场所相比,报告在 GP 处进行检测后讨论的比例没有差异。
结论
HCV 检测最常由参与者的常规 GP 进行。GP 目前与其他更专业的场所一样,提供检测和检测后讨论的比例相似。然而,在接受采访的抗体阳性 PWID 中,超过三分之一的人没有进行 RNA 检测。我们的研究结果表明,一般实践环境是 PWID 获得 HCV 检测的常见和可及的场所。针对 GP 以改善对阳性抗体检测的随访,可能有助于改善患者通过 HCV 护理级联的进展。