Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.
Outpatient Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado, USA.
J Infect Dis. 2020 Sep 2;222(Suppl 5):S384-S391. doi: 10.1093/infdis/jiz694.
In the United States, many opioid treatment programs (OTPs) do not offer viral hepatitis (VH) or human immunodeficiency virus (HIV) testing despite high prevalence among OTP clients. We initiated an opt-out VH and HIV testing and linkage-to-care program within our OTP.
All OTP intakes are screened for VH and HIV and evaluated for rescreening annually. A patient navigator reviews laboratory results and provides counseling in the OTP clinic. The medical record is queried to identify individuals with previously diagnosed, untreated VH or HIV. Navigation support is provided for linkage or relinkage to VH or HIV care.
Between March 2018 and Februrary 2019, 532 individuals were screened for hepatitis C virus (HCV), 180 tested HCV antibody positive (34%), and 108 were HCV-ribonucleic acid (RNA) positive (20%). Sixty individuals were identified with previously diagnosed, untreated HCV. Of all HCV RNA+, 49% reported current injection drug use (82 of 168). Ninety-five individuals were seen by an HCV specialist (57% of HCV RNA+), 72 started treatment (43%), and 69 (41%) completed treatment. Individuals with primary care providers were most likely to start treatment. Four individuals were diagnosed with hepatitis B; 0 were diagnosed with HIV.
The implementation of an OTP-based screening and navigation protocol has enabled significant gains in the identification and treatment of VH in this high prevalence setting.
在美国，尽管阿片类药物治疗计划（OTP）的客户中病毒肝炎（VH）和人类免疫缺陷病毒（HIV）的患病率很高，但许多 OTP 并未提供 VH 或 HIV 检测。我们在 OTP 中启动了一项选择退出 VH 和 HIV 检测和联系护理计划。
所有 OTP 摄入均进行 VH 和 HIV 筛查，并每年评估是否需要重新筛查。患者导航员会查看实验室结果，并在 OTP 诊所提供咨询。查询医疗记录以确定以前患有未经治疗的 VH 或 HIV 的个人。为 VH 或 HIV 护理的联系或重新联系提供导航支持。
2018 年 3 月至 2019 年 2 月期间，筛查了 532 人是否患有丙型肝炎病毒（HCV），其中 180 人 HCV 抗体阳性（34％），108 人 HCV-核糖核酸（RNA）阳性（20％）。有 60 人被诊断为先前患有未经治疗的 HCV。在所有 HCV RNA+中，有 49％（82/168）报告当前使用注射毒品。有 95 人接受了 HCV 专家的检查（HCV RNA+的 57％），72 人开始治疗（43％），69 人（41％）完成治疗。有初级保健提供者的个人最有可能开始治疗。有 4 人被诊断患有乙型肝炎；0 人被诊断患有 HIV。
在这种高流行地区，实施 OTP 为基础的筛查和导航方案可大大提高 VH 的识别和治疗水平。
