Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, MD.
Hepatology. 2021 Apr;73(4):1261-1274. doi: 10.1002/hep.31461. Epub 2021 Jan 22.
Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India.
We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV.
Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.
获取基本医疗需求仍然是世界上大多数人口面临的挑战。在这项研究中，我们为印度东北部的阿鲁纳恰尔邦（Arunachal Pradesh）一个极其偏远和边缘化的人群开发了一种预防和特定疾病保健的护理模式。
我们通过一个基于平板电脑的数据采集应用程序在阿鲁纳恰尔邦的偏远村庄进行了患者筛查、访谈和血液样本采集，然后将其同步到云数据库进行存储。我们在中央实验室对乙型肝炎病毒（HBV）的阳性病例进行了确认和基因分型。进行的血液检查包括肝功能检查、HBV 血清学和 HBV 基因分型。根据需要提供 HBV 疫苗接种。我们从阿鲁纳恰尔邦的 5 个最西部的地区共访谈了 11818 名参与者，采集了 11572 个样本，为 5176 名参与者进行了疫苗接种。结果发现，总体乙型肝炎表面抗原（HBsAg）流行率为 3.6%（n=419）。共有 34.6%的人乙型肝炎 e 抗原阳性（n=145），25.5%的人 HBV DNA 水平大于 20000IU/mL（n=107）。基因分型分析表明，许多患者感染了 HBV C/D 重组体。某些部落的血清阳性率较高，Miji 部落和 Nishi 部落的阳性率分别为 9.8%和 6.3%。报告有医疗注射史的个体的 HBsAg 流行率为 3.5%，低于 HBV 的总体流行率。
我们独特的、简单的护理模式能够将资源极度有限的人群与筛查、预防接种、后续治疗护理以及分子流行病学联系起来，利用电子平台确定人群的迁徙性质和疾病。这种护理模式可以在全球其他类似环境中应用。
