Tulane University School of Medicine, New Orleans, LA, USA.
J Racial Ethn Health Disparities. 2018 Oct;5(5):1052-1058. doi: 10.1007/s40615-017-0453-y. Epub 2017 Dec 29.
This study assessed racial disparities in access to healthcare services, hepatitis C virus (HCV) exposure, and retention in a treatment cascade in two indigent populations in an urban center in the Southern US.
PARTICIPANTS/METHODS: Opt-in HCV antibody screening was offered at two large homeless centers and three residential substance abuse treatment centers (SATCs) in New Orleans, LA. Five hundred ninety-four participants experiencing homelessness and 342 residents of SATCs were assessed for previous access/perceived barriers to healthcare services and high-risk behaviors associated with HCV exposure. Participants were then screened using rapid HCV antibody testing and tracked through a treatment cascade involving referral to a primary care provider (PCP), RNA confirmation, and specialist referral.
In both the homeless and SATC populations, whites were more likely to report barriers to accessing healthcare and high-risk behaviors, especially prior intravenous drug use (IVDU). Interaction between age and race demonstrates a protective effect of white ethnicity at higher ages, at a level approaching statistical significance. Non-whites were equally likely to access follow-up care and treatment as whites.
Despite many more risk factors reported by the white population, HCV antibody positivity was largely equal between the two racial groups. Known interactions between race and age in the African American population were demonstrated in these high-risk, urban populations. Whites were no more likely to achieve various levels of a treatment and care cascade. The results may demonstrate the impact of improved access to testing services and primary care, although access to treatment remains a significant barrier to eliminating racial disparities in HCV infection.
本研究评估了美国南部一个城市中心的两个贫困人群中，在获得医疗保健服务、丙型肝炎病毒 (HCV) 暴露以及在治疗阶梯中保留方面存在的种族差异。
参与者/方法：在新奥尔良的两个大型无家可归者中心和三个住宅药物滥用治疗中心 (SATC) 提供了 HCV 抗体的选择检测。对 594 名无家可归者和 342 名 SATC 居民进行了评估，以了解他们之前获得/感知到的医疗保健服务障碍以及与 HCV 暴露相关的高风险行为。然后使用快速 HCV 抗体检测对参与者进行筛查，并通过包括转介至初级保健提供者 (PCP)、RNA 确认和专科转介的治疗阶梯进行跟踪。
在无家可归者和 SATC 人群中，白人更有可能报告获得医疗保健服务的障碍和高风险行为，尤其是既往静脉内药物使用 (IVDU)。年龄和种族之间的相互作用表明，在更高年龄时，白人种族具有保护作用，接近统计学意义。非白人在获得后续护理和治疗方面与白人一样可能。
尽管白人报告了更多的风险因素，但 HCV 抗体阳性率在两个种族群体之间基本相同。在这些高风险的城市人群中，也证明了非裔美国人中种族和年龄之间的已知相互作用。白人在达到治疗和护理阶梯的各个水平方面没有更高的可能性。结果可能表明，由于获得了更多的检测服务和初级保健服务，因此消除 HCV 感染方面的种族差异的效果得到了改善，尽管获得治疗仍然是消除种族差异的一个重要障碍。
