Vold Jørn Henrik, Aas Christer, Leiva Rafael Alexander, Vickerman Peter, Chalabianloo Fatemeh, Løberg Else-Marie, Johansson Kjell Arne, Fadnes Lars Thore
Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
BMC Infect Dis. 2019 Apr 4;19(1):306. doi: 10.1186/s12879-019-3918-2.
Various integrated care models have been used to improve treatment completion of medications for chronic hepatitis B virus (HBV), chronic hepatitis C virus (HCV), Mycobacterium tuberculosis (TB), and Human immunodeficiency virus (HIV) among people with substance use disorders (SUD). We have conducted a systematic review to evaluate whether integrated models have impacts of the treatment of infectious diseases among marginalized people with SUD.
We searched MEDLINE/PubMed (1946 to 2018, on July 26, 2018) and Embase (from 1974 to 2018, on July 26, 2018) for randomized controlled trials (RCTs) and cohort studies evaluating diverse integrated models' effects on sustained virological response (SVR), HIV suppression, HBV curation or suppression, completion of TB treatment regimen among people with SUD. The included studies were assessed qualitatively.
Altogether, 1640 studies, and references to 1135 related reviews and RCTs were considered, and only seven RCTs and three cohort studies fulfilled the inclusion criteria. We identified nine integrated care models. Two studies, one RCT and one cohort study, showed a significant effect of their integrated models. The RCT evaluated psychosocial treatment, opioid agonist treatment (OAT) and directly observed TB treatment, and found a significant increase in TB treatment completions among intervention group compared to control group (60% versus 13%, p < 0.01). The cohort study including OAT and TB treatments had an effect on TB treatment completion in hospitalized patients (89% versus 73%, p = 0.03). Eight out of ten studies showed no significant effects of their integrated care models on defined outcomes. One of which having included 363 participants in a RCT showed no effect on SVR compared to the control group when the results adjusted for active substance use and alcohol dependence in a post-hoc analysis (11% versus 7%, p = 0.49).
The findings indicate uncertainty on the effects of integrated care models' on treatment for severe infectious diseases among people with SUD. Some studies point toward that integrated models could improve care of people with SUD, yet high-quality studies and preferably, sufficiently sized clinical trials are needed to conclude on the degree of impact.
多种综合护理模式已被用于提高物质使用障碍（SUD）患者中慢性乙型肝炎病毒（HBV）、慢性丙型肝炎病毒（HCV）、结核分枝杆菌（TB）和人类免疫缺陷病毒（HIV）治疗的药物完成率。我们进行了一项系统评价，以评估综合模式对边缘化SUD患者的传染病治疗是否有影响。
我们检索了MEDLINE/PubMed（1946年至2018年，2018年7月26日）和Embase（1974年至2018年，2018年7月26日），以查找评估不同综合模式对SUD患者的持续病毒学应答（SVR）、HIV抑制、HBV治愈或抑制、结核治疗方案完成情况影响的随机对照试验（RCT）和队列研究。对纳入的研究进行定性评估。
总共考虑了1640项研究以及1135篇相关综述和RCT的参考文献，只有7项RCT和3项队列研究符合纳入标准。我们确定了9种综合护理模式。两项研究，一项RCT和一项队列研究，显示其综合模式有显著效果。该RCT评估了心理社会治疗、阿片类激动剂治疗（OAT）和直接观察下的结核治疗，发现干预组的结核治疗完成率相比对照组显著提高（60%对13%，p < 0.01）。包括OAT和结核治疗的队列研究对住院患者的结核治疗完成情况有影响（89%对73%，p = 0.03）。十项研究中有八项显示其综合护理模式对既定结果无显著影响。其中一项在RCT中纳入363名参与者的研究，在事后分析中对活性物质使用和酒精依赖进行调整后发现，与对照组相比，对SVR无影响（11%对7%，p = 0.49）。
研究结果表明综合护理模式对SUD患者严重传染病治疗效果存在不确定性。一些研究指出综合模式可改善SUD患者的护理，但需要高质量研究，最好是足够规模的临床试验来确定影响程度。
