在阿片类药物流行期间，对美国联邦合格健康中心的全国样本进行 HCV 检测和治疗。
HCV Testing and Treatment in a National Sample of US Federally Qualified Health Centers during the Opioid Epidemic.
机构信息
Section of Infectious Disease, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA, 02118, USA.
Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
出版信息
J Gen Intern Med. 2020 May;35(5):1477-1483. doi: 10.1007/s11606-020-05701-9. Epub 2020 Mar 4.
BACKGROUND
Federally qualified health centers (FQHCs) serve diverse communities in the United States (U.S.) and could function as important venues to diagnose and treat hepatitis C virus (HCV) infections.
OBJECTIVE
To determine HCV testing proportion and factors associated with treatment initiation, and treatment outcomes in a large sample of FQHCs around the U.S.
DESIGN
Retrospective cohort study using electronic health records of three hundred and forty-one FQHC clinical sites participating in the OCHIN network in 19 U.S. states.
PARTICIPANTS
Adult patients (≥ 18 years of age) seen between January 01, 2012, and June 30, 2017.
MAIN MEASURES
HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 6 months after treatment initiation.
KEY RESULTS
Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8694 (9.8%) of individuals tested had reactive results. Of the 6357 with HCV RNA testing, 4092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 87% reached SVR. Having commercial insurance (aOR, 2.11; 95% CI, 1.46-3.05), older age (aOR, 1.07; 95% CI, 1.06-1.09), and being Hispanic/Latino (aOR, 1.87; 95% CI, 1.38-2.53) or Asian/Pacific Islander (aOR, 2.47; 95% CI, 1.46-4.19) were independently associated with higher odds of treatment initiation after multivariable adjustment. In contrast, women (aOR, 0.76; 95% CI, 0.60-0.97) and the uninsured (aOR, 0.15; 95% CI, 0.09-0.25) were less likely to initiate treatment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV.
CONCLUSIONS
Fewer than 20% of individuals with identified OUD were tested for HCV. SVR was lower than findings in other real-world cohorts. Measures to improve outcomes should be considered with the expansion of HCV management into community clinics.
背景
联邦合格的健康中心（FQHC）为美国（美国）的不同社区提供服务，并且可以作为诊断和治疗丙型肝炎病毒（HCV）感染的重要场所。
目的
确定 HCV 检测比例以及与美国各地大量 FQHC 中治疗启动和治疗结局相关的因素。
设计
使用参与美国 19 个州 OCHIN 网络的 341 个 FQHC 临床站点的电子健康记录进行回顾性队列研究。
参与者
2012 年 1 月 1 日至 2017 年 6 月 30 日期间就诊的≥18 岁成人患者。
主要措施
根据阿片类药物使用障碍（OUD）的诊断，分层 HCV 检测比例；治疗启动率；以及持续病毒学应答（SVR），定义为治疗开始后 6 个月 HCV RNA 不可检测。
主要结果
在符合纳入标准的 1508525 名患者中，有 88384 名（5.9%）接受了 HCV 检测，有 8694 名（9.8%）检测结果呈阳性。在 6357 名接受 HCV RNA 检测的患者中，有 4092 名（64.4%）的 RNA 可检测到。有慢性 HCV 且可评估数据的患者中，有 12%接受了治疗。其中，87%达到 SVR。有商业保险（优势比，2.11；95%置信区间，1.46-3.05）、年龄较大（优势比，1.07；95%置信区间，1.06-1.09）、西班牙裔/拉丁裔（优势比，1.87；95%置信区间，1.38-2.53）或亚裔/太平洋岛民（优势比，2.47；95%置信区间，1.46-4.19）与多变量调整后的更高治疗启动几率独立相关。相比之下，女性（优势比，0.76；95%置信区间，0.60-0.97）和无保险者（优势比，0.15；95%置信区间，0.09-0.25）不太可能开始治疗。只有 8%的慢性 HCV 患者接受了 HIV 检测，而 15%的有 OUD 诊断的患者接受了 HCV 检测。
结论
只有不到 20%的有 OUD 诊断的患者接受了 HCV 检测。SVR 低于其他真实世界队列的发现。随着 HCV 管理扩展到社区诊所，应考虑采取措施改善治疗结果。
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