NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
United Lincolnshire Hospitals Lincoln County Hospital, Lincoln, UK.
Addiction. 2019 Jun;114(6):1113-1122. doi: 10.1111/add.14569. Epub 2019 Mar 12.
Previous studies have shown low rates of diagnosis and treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID). Our aims were to test the effect of a complex intervention [Hepatitis C Awareness Through to Treatment (HepCATT)] in drug and alcohol clinics-primarily, on engagement of HCV-positive PWID with therapy and, secondarily, on testing for HCV, referral to hepatology services and start of HCV treatment.
A non-randomized pilot study in three specialist addiction clinics in England comparing an intervention year (starting between September 2015 and February 2016) with a baseline year (2014), together with three control clinics.
Analysis included all attendees at the intervention and control specialist addiction clinics identified as PWID.
The intervention comprised the placement of a half-time facilitator in each clinic for 12 months with the brief to increase diagnosis of HCV infection within clients at those services and the engagement of diagnosed individuals with an appropriate care pathway. The facilitator undertook various activities, which could include training of key workers, direct interaction with clients, streamlining and support for hepatology appointments and introduction of dried blood-spot testing.
For each clinic and period, we obtained the total number of clients and, as relevant, their status as PWID, tested for HCV, known HCV-positive, engaged with HCV therapy or treated.
Compared with baseline, there was strong evidence that engagement with HCV therapy in the intervention year increased (P < 0.001) more in the HepCATT centres than controls, up 31 percentage points [95% confidence interval (CI) = 19-43] versus -12 (CI = -31 to 6) and odds ratio (OR) = 9.99 (CI = 4.42-22.6) versus 0.35 (CI = 0.08-1.56). HepCATT centres also had greater increases in HCV testing (OR = 3.06 versus 0.78, P < 0.001), referral to hepatology (OR = 9.60 versus 0.56, P < 0.001) and treatment initiation (OR = 9.5 versus 0.74, P < 0.001).
Introducing a half-time facilitator into drug and alcohol clinics in England increased engagement of HCV-positive people who inject drugs with hepatitis C virus care pathways, with increased uptake also of testing, referral to hepatology and initiation of treatment.
先前的研究表明，在注射毒品者（PWID）中，丙型肝炎病毒（HCV）感染的诊断和治疗率较低。我们的目的是检验一项复杂干预措施[丙型肝炎意识治疗（HepCATT）]在药物和酒精诊所的效果，主要是评估 HCV 阳性的 PWID 接受治疗的情况，其次是评估 HCV 检测、转介至肝病服务和开始 HCV 治疗的情况。
在英格兰的三个专科成瘾诊所进行的一项非随机试点研究，将干预年（2015 年 9 月至 2016 年 2 月之间开始）与基线年（2014 年）进行比较，同时还与三个对照诊所进行比较。
分析包括在干预和对照专科成瘾诊所中被确定为 PWID 的所有就诊者。
该干预措施包括在每个诊所配置一名兼职协调员，为期 12 个月，任务是增加这些服务中 HCV 感染患者的诊断，并使确诊患者参与适当的护理途径。协调员开展了各种活动，包括对关键工作人员进行培训、与客户直接互动、简化和支持与肝病预约以及引入干血斑检测。
对于每个诊所和每个时期，我们获得了就诊者的总数，以及相关的 PWID 状态、HCV 检测情况、已知 HCV 阳性情况、接受 HCV 治疗或治疗情况。
与基线相比，在干预年中，接受 HCV 治疗的患者比例在 HepCATT 中心明显增加（P<0.001），比对照组高出 31 个百分点[95%置信区间（CI）=19-43]，而对照组则减少了 12 个百分点[CI=-31 至 6]，优势比（OR）为 9.99[CI=4.42-22.6]，而对照组为 0.35[CI=0.08-1.56]。HepCATT 中心的 HCV 检测率也有更大的提高（OR=3.06，P<0.001）、转介至肝病科（OR=9.60，P<0.001）和治疗开始（OR=9.5，P<0.001）。
在英格兰的药物和酒精诊所引入兼职协调员，增加了 HCV 阳性的注射毒品者接受丙型肝炎病毒护理途径的机会，同时也增加了检测、转介至肝病科和开始治疗的机会。
