Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
Department of Gastroenterology, Sengkang General Hospital, Singapore.
Singapore Med J. 2022 Feb;63(2):86-92. doi: 10.11622/smedj.2020116. Epub 2020 Jul 30.
Linkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group.
All participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment.
351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis.
PoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.
在药物滥用者中，将其与医疗服务联系起来仍然是消除丙型肝炎病毒（HCV）的障碍。我们旨在确定在这一人群中，使用即时护理（PoC）教育、对肝脏疾病进行筛查和分期并直接转至医院是否能提高与医疗服务的联系。
所有参与者都接受了即时护理教育和 HCV 筛查。HCV 阳性参与者被随机分配至标准护理（对照组）或直接接入组，后者提供了一条直接通往医院的途径。通过查阅电子病历来确定与医疗服务的联系情况。将护理联系的级联定义为参加专家诊所、通过 HCV RNA 检测确认病毒血症、讨论 HCV 治疗和开始治疗。
共对 351 名中途之家居民进行了筛查。总体 HCV 流行率为 30.5%（n = 107），对照组有 69 名居民，直接接入组有 38 名。直接接入组有显著更高比例的病例被联系到专家进行确认 RNA 检测（63.2% vs. 40.6%，p = 0.025）、讨论 HCV 治疗（p = 0.009）和开始治疗（p = 0.01），与对照组相比。总体而言，只有 12.6%（n = 13）在随访期间开始了治疗。多变量分析显示，即时护理 HCV 筛查联合直接转介显著提高了 HCV 治疗开始的联系（调整后的优势比 9.13，p = 0.005）。
即时护理 HCV 筛查联合直接转介可提高与医疗服务的联系，并简化 HCV 护理级联，从而提高治疗的接受率。即时护理教育、筛查、诊断和治疗可能是在这一人群中实现 HCV 微消除的有效策略。
