疾病预防控制中心关于丙型肝炎检测的建议：阿巴拉契亚急诊部门需要采用普遍筛查。

Centers for Disease Control and Prevention Recommendations for Hepatitis C Testing: The Need to Adopt Universal Screening in an Appalachian Emergency Department.

机构信息

From the, Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, WV.

the, Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV.

出版信息

Acad Emerg Med. 2020 Sep;27(9):844-852. doi: 10.1111/acem.13932. Epub 2020 Feb 28.

DOI:10.1111/acem.13932

PMID:32017316

Abstract

BACKGROUND

The Centers for Disease Control and Prevention recommends screening baby boomers and high-risk patients for hepatitis C virus (HCV); however, the incidence of HCV is rapidly increasing among younger populations, and screening is limited by access to care and risk factor assessment. The purpose of this study was to evaluate characteristics of HCV antibody-positive (Ab+) and ribonucleic acid (RNA)-confirmed-positive patients identified via two screening models in an Appalachian emergency department (ED).

METHODS

This was a retrospective cohort study of patients who screened HCV Ab+ in the ED from January 1 to October 31, 2018. Data were extracted, and comparative analyses were conducted between the risk-based and the universal screening models.

RESULTS

Overall, 444 patients screened HCV Ab+, with a median age of 39 years. From January to May 2018, the risk factor model identified 126 HCV Ab+ patients out of 3,014 screened (4%), whereas from June to October 2018, the universal model identified 318 HCV Ab+ patients out of 5,407 screened (6%; p < 0.001). A consistently large proportion of diagnoses were new (71%). There was no statistically significant decrease between the RNA-confirmed-positive patients during the risk factor model (76, 60%) and universal model (186, 58%) time periods (p = 0.72). The models had high rates of reported intravenous drug use, and the universal screening adoption was modest at 33%.

CONCLUSION

This study was the first to present characteristics of HCV Ab+ and RNA-confirmed-positive patients identified during the transition to a universal screening model in an Appalachian ED. Most diagnoses were new regardless of screening model, but more patients screened HCV Ab+, and a similar proportion were RNA-confirmed-positive, under the universal model. Given that adoption of universal screening was modest, and risk factors remained similar, future research should investigate how to more effectively implement a universal screening model on a wider scale to identify early infections.

摘要

背景

疾病控制与预防中心建议对婴儿潮一代和高危患者进行丙型肝炎病毒 (HCV) 筛查；然而，HCV 在年轻人群中的发病率迅速上升，并且由于获得医疗服务和进行风险因素评估的机会有限，筛查受到限制。本研究的目的是评估通过阿巴拉契亚急诊部门 (ED) 中的两种筛选模型识别出的 HCV 抗体阳性 (Ab+) 和核糖核酸 (RNA) 确诊阳性患者的特征。

方法

这是一项回顾性队列研究，纳入了 2018 年 1 月 1 日至 10 月 31 日在 ED 筛查 HCV Ab+的患者。提取数据，并对基于风险和普遍筛查模型进行了比较分析。

结果

总体而言，444 名患者在 ED 筛查 HCV Ab+，中位年龄为 39 岁。2018 年 1 月至 5 月期间，风险因素模型在 3014 名筛查患者中识别出 126 名 HCV Ab+患者（4%），而 2018 年 6 月至 10 月期间，通用模型在 5407 名筛查患者中识别出 318 名 HCV Ab+患者（6%；p<0.001）。诊断结果中有很大一部分是新诊断（71%）。在风险因素模型（76 例，60%）和通用模型（186 例，58%）时间段内，RNA 确诊阳性患者的数量没有统计学显著下降（p=0.72）。两种模型中报告的静脉内药物使用比例均较高，通用筛查的采用率仅为 33%。

结论

本研究首次介绍了在阿巴拉契亚 ED 向通用筛查模型过渡期间，通过两种模型识别出的 HCV Ab+和 RNA 确诊阳性患者的特征。无论采用哪种筛查模型，大多数诊断都是新诊断，但在通用模型下，筛查 HCV Ab+的患者更多，RNA 确诊阳性的比例相似。考虑到通用筛查的采用率较低，且风险因素保持相似，未来的研究应调查如何更有效地在更广泛的范围内实施通用筛查模型，以识别早期感染。