Murtagh Ross, Swan Davina, O'Connor Eileen, McCombe Geoff, Lambert John S, Avramovic Gordana, Cullen Walter
University College Dublin, Dublin, Ireland.
Mater Misericordiae University Hospital, Dublin, Ireland.
Interact J Med Res. 2018 Dec 19;7(2):e10313. doi: 10.2196/10313.
Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80% new infections occurring among people who inject drugs (PWID).
We aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality.
We included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care.
The baseline data were collected from clinical records of 134 patients; 72.2% (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8% (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9% (99/127) tested positive. Then, 83.6% (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3% (7/112) tested HIV positive. Moreover, 66.4% (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8% (7/89) of those were positive. In the 12 months before the study, 30.6% (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0% (8/134) received a brief intervention, and 2.2% (3/134) were referred to a specialist addiction or alcohol treatment service.
With general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion.
丙型肝炎病毒（HCV）感染是慢性肝病和死亡的主要原因。注射吸毒目前是爱尔兰和全球丙型肝炎病毒传播的主要途径之一，估计80%的新感染发生在注射吸毒者（PWID）中。
我们旨在研究爱尔兰初级保健机构中接受阿片类药物替代疗法的患者在丙型肝炎病毒筛查方面是否接受了符合指南的护理。爱尔兰已经制定了在初级保健环境中提供阿片类药物替代治疗的护理模式。鉴于目前旨在扩大干预措施以减少慢性丙型肝炎病毒感染和相关死亡率的指南，以及为注射吸毒者提供护理的场所从二级保健转向初级保健，我们开展了这项研究。
我们纳入了Heplink研究都柏林站点的基线数据，这是一项可行性研究，重点是开发复杂干预措施以加强基于社区的丙型肝炎病毒治疗，并改善初级和二级保健之间的丙型肝炎病毒护理途径。我们从研究联盟成员的专业网络和数据库中招募了14家开具阿片类药物替代治疗处方的全科医疗机构。使用标准化的非概率抽样框架从每家机构中确定10名患者参与研究。年龄≥18岁、正在接受阿片类药物替代治疗且在招募期间因任何原因就诊于该机构的患者符合入选条件。基线数据从参与研究患者的临床记录中收集。我们收集并分析了关于人口统计学特征、丙型肝炎病毒和其他血源病毒的护理过程及结果、尿液分析检测结果、酒精使用障碍、慢性病以及卫生服务利用的数据。我们检查了患者是否接受了与丙型肝炎病毒筛查和护理相关指南一致的护理。
基线数据来自134名患者的临床记录；72.2%（96/134）为男性；（平均年龄43岁，标准差7.6；范围27 - 71岁）；94.8%（127/134）的患者一生中接受过抗丙型肝炎病毒抗体检测；其中，77.9%（99/127）检测呈阳性。然后，83.6%（112/134）的患者一生中接受过艾滋病毒抗体检测；其中，6.3%（7/112）检测呈艾滋病毒阳性。此外，66.4%（89/134）的患者一生中接受过乙型肝炎病毒检测，其中8%（7/89）呈阳性。在研究前的12个月里，30.6%（41/134）的患者被全科医生询问过饮酒情况，6.0%（8/134）接受了简短干预，2.2%（3/134）被转介至专科成瘾或酒精治疗服务机构。
随着全科医疗和初级保健在丙型肝炎病毒护理中发挥越来越重要的作用，本研究强调了优先开发和评估支持患者从诊断到治疗完成的实际临床解决方案的重要性。
