Aisyah D N, Shallcross L, Hayward A, Aldridge R W, Hemming S, Yates S, Ferenando G, Possas L, Garber E, Watson J M, Geretti A M, McHugh T D, Lipman M, Story A
UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.
Faculty of Public Health Universitas Indonesia, Depok, Indonesia.
J Viral Hepat. 2018 Nov;25(11):1260-1269. doi: 10.1111/jvh.12936. Epub 2018 Jun 20.
Injecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common in the homeless and prisoners. Capturing accurate data on disease prevalence within these groups is challenging but is essential to inform strategies to reduce HCV transmission. The aim of this study was to estimate the prevalence of HCV in these populations. We conducted a cross-sectional study between May 2011 and June 2013 in London and, using convenience sampling, recruited participants from hostels for the homeless, drug treatment services and a prison. A questionnaire was administered and blood samples were tested for hepatitis C. We recruited 491 individuals who were homeless (40.7%), 205 drug users (17%) and 511 prisoners (42.3%). Eight per cent of patients (98/1207, 95% CI: 6.7%-9.8%) had active HCV infection and 3% (38/1207, 95% CI: 2.3%-4.3%) past HCV infection. Overall, one quarter (51/205) of people recruited in drug treatment services, 13% (65/491) of people from homeless residential sites and 4% (20/511) prisoners in this study were anti-HCV positive. Seventy-seven of the 136 (56.6%, 95% CI: 47.9%-65%) of HCV infected participants identified had a history of all three risk factors (homelessness, imprisonment and drug use), 27.3% (95% CI: 20.1%-35.6%) had 2 overlapping risk factors, and 15.4% (95% CI: 10.6%-23.7%) one risk factor. Drug treatment services, prisons and homelessness services provide good opportunities for identifying hepatitis C-infected individuals. Effective models need to be developed to ensure case identification in these settings that can lead to an effective treatment and an efficient HCV prevention.
注射毒品会大幅增加丙型肝炎病毒（HCV）感染风险，在无家可归者和囚犯中很常见。获取这些群体中疾病流行率的准确数据具有挑战性，但对于为减少HCV传播的策略提供信息至关重要。本研究的目的是估计这些人群中HCV的流行率。我们于2011年5月至2013年6月在伦敦进行了一项横断面研究，并采用便利抽样法，从为无家可归者提供的旅社、戒毒治疗服务机构和一所监狱招募参与者。发放了一份问卷，并对血液样本进行了丙型肝炎检测。我们招募了491名无家可归者（40.7%）、205名吸毒者（17%）和511名囚犯（42.3%）。8%的患者（98/1207，95%置信区间：6.7%-9.8%）有活动性HCV感染，3%（38/1207，95%置信区间：2.3%-4.3%）有既往HCV感染。总体而言，本研究中，戒毒治疗服务机构招募的人员中有四分之一（51/205）、无家可归者居住场所的人员中有13%（65/491）以及囚犯中有4%（20/511）抗-HCV呈阳性。在136名（56.6%，95%置信区间：47.9%-65%）已确定感染HCV的参与者中，77人有所有三种风险因素（无家可归、入狱和吸毒）的病史，27.3%（95%置信区间：20.1%-35.6%）有两种重叠的风险因素，15.4%（95%置信区间：10.6%-23.7%）有一个风险因素。戒毒治疗服务机构、监狱和无家可归者服务机构为识别HCV感染个体提供了良好机会。需要建立有效的模式，以确保在这些环境中进行病例识别，从而实现有效的治疗和高效的HCV预防。
