Elsharkawy Ahmed Mohamed, Miller Carolyn, Hearn Andrea, Buerstedde Gertrud, Price Ashley, McPherson Stuart
Liver Unit, University Hospitals Birmingham, Birmingham, UK.
Liver Unit, Freeman Hospital, Newcastle Upon Tyne, UK.
Frontline Gastroenterol. 2013 Apr;4(2):125-129. doi: 10.1136/flgastro-2012-100282. Epub 2012 Dec 14.
Chronic hepatitis C infection (HCV) is common in injecting drug users and is a major cause of liver disease. Antiviral treatment can 'cure' HCV, but is frequently associated with side effects and requires regular monitoring. Non-attendance at hospital appointments is frequent. To try and improve attendance and increase the number of current and previous injecting drug users treated we developed three outreach clinics.
To review the outcome of patients referred to the outreach clinics.
Retrospective service review of three clinics at drug treatment centres in Newcastle and Northumberland. Data was collected on attendance rates, patient demographics, treatment rates and outcomes.
141 referrals were received across the three sites with an overall attendance rate of 75% (106 patients, 79% men and median age 36), which compared favourably with that at our hospital (50%). All patients were on methadone/subutex. 45% were infected with Genotype 1 HCV. 10% were cirrhotic. To date, 30% have started treatment and 21% are waiting to start or are still in workup. 13% elected to delay treatment due to early stage disease and 11% were not ready for treatment on psychological or social grounds. Only 12% failed to attend follow up after initial assessment. To date, 24 patients have completed full courses of treatment with sustained viral response in 13 patients. Results are awaited for seven patients.
The development of outreach clinics for HCV in drug treatment centres can substantially improve clinic attendance and increase access to treatment in this marginalised group.
丙型肝炎病毒（HCV）慢性感染在注射吸毒者中很常见，是肝脏疾病的主要病因。抗病毒治疗可“治愈”HCV，但常伴有副作用，且需要定期监测。患者经常不按时到医院就诊。为了努力提高就诊率并增加当前和既往注射吸毒者接受治疗的人数，我们设立了三家外展诊所。
回顾转诊至外展诊所的患者的治疗结果。
对纽卡斯尔和诺森伯兰郡戒毒治疗中心的三家诊所进行回顾性服务评估。收集了关于就诊率、患者人口统计学特征、治疗率和治疗结果的数据。
三个地点共收到141例转诊，总体就诊率为75%（106例患者，男性占79%，中位年龄36岁），与我院的就诊率（50%）相比更具优势。所有患者均服用美沙酮/丁丙诺啡。45%的患者感染了1型HCV。10%的患者患有肝硬化。迄今为止，30%的患者已开始治疗，21%的患者正在等待开始治疗或仍在检查中。13%的患者因疾病处于早期而选择推迟治疗，11%的患者因心理或社会原因尚未准备好接受治疗。只有12%的患者在初次评估后未参加随访。迄今为止，24例患者已完成全部疗程的治疗，13例患者实现了持续病毒学应答。7例患者的结果有待观察。
在戒毒治疗中心设立HCV外展诊所可大幅提高就诊率，并增加这一边缘化群体获得治疗的机会。
