评估同伴支持性筛查作为囚犯丙型肝炎病例发现模式。
Evaluating peer-supported screening as a hepatitis C case-finding model in prisoners.
机构信息
Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland.
School of Medicine, University College Dublin, Dublin, Ireland.
出版信息
Harm Reduct J. 2019 Jul 5;16(1):42. doi: 10.1186/s12954-019-0313-7.
BACKGROUND
Hepatitis C Virus (HCV) infection is endemic in prison populations, and HCV management in prisons is suboptimal. Incarceration is a public health opportunity to target this cohort. Community peer support increases HCV screening and treatment uptake. Prison peer workers have the potential to support the engagement of prisoners with health services and reduce stigma. This study's primary aim is to evaluate peer-supported screening as a model of active HCV case finding with a secondary aim to describe the HCV cascade among those infected including linkage to care and treatment outcomes.
METHODS
An observational study was conducted in a medium-security Irish male prison housing 538 inmates, using a risk-based questionnaire, medical records, peer-supported screening, laboratory-based HCV serology tests and mobile elastography.
RESULTS
A prison peer-supported screening initiative engaged large numbers of prisoners in HCV screening (n = 419). The mean age of participants was 32.8 years, 92% were Irish and 33% had a history of injecting drug use. Multiple risk factors for HCV acquisition were identified including needle sharing (16%). On serological testing, 87 (21%) were HCV Ab +ve and 50 (12%) were HCV RNA +ve of whom 80% were fibroscaned (25% showing evidence of liver disease). Eighty-six percent of those with active infection were linked with HCV care, with 33% undergoing or completing treatment. There was a high concordance with HCV disclosure at committal and serological testing (96% for HCV Ab +ve and 89% for HCV Ab -ve).
CONCLUSION
Peer-supported screening is an effective active HCV case-finding model to find and link prisoners with untreated active HCV infection to HCV care.
背景
丙型肝炎病毒（HCV）感染在监狱人群中流行，监狱内的 HCV 管理并不理想。监禁是针对这一人群的一个公共卫生机会。社区同伴支持可提高 HCV 筛查和治疗的参与率。监狱同伴工作者有潜力支持囚犯与卫生服务机构的接触，并减少耻辱感。本研究的主要目的是评估同伴支持的筛查作为一种主动 HCV 病例发现模式，次要目的是描述感染 HCV 的患者的 HCV 级联情况，包括与护理的联系和治疗结果。
方法
在一所容纳 538 名囚犯的中等安全级别的爱尔兰男子监狱中进行了一项观察性研究，使用基于风险的问卷、医疗记录、同伴支持的筛查、基于实验室的 HCV 血清学检测和移动弹性成像。
结果
一项监狱同伴支持的筛查计划使大量囚犯参与了 HCV 筛查（n=419）。参与者的平均年龄为 32.8 岁，92%是爱尔兰人，33%有注射吸毒史。确定了 HCV 感染的多种危险因素，包括共用针头（16%）。在血清学检测中，87（21%）例 HCV Ab +ve，50（12%）例 HCV RNA +ve，其中 80%进行了肝弹性成像（25%显示有肝脏疾病证据）。有活动感染的患者中有 86%与 HCV 护理相关联，其中 33%正在接受或完成治疗。在入院时和血清学检测时 HCV 的披露高度一致（HCV Ab +ve 为 96%，HCV Ab -ve 为 89%）。
结论
同伴支持的筛查是一种有效的主动 HCV 病例发现模式，可以发现和联系未接受治疗的有活动感染的 HCV 感染的囚犯，并将其与 HCV 护理联系起来。
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