越南城市中注射毒品人群中丙型肝炎病毒检测率低。
Reported Low Uptake of HCV Testing among People Who Inject Drugs in Urban Vietnam.
机构信息
Center for Research and Training on Substance Use-HIV, Hanoi Medical University, Hanoi 100000, Vietnam.
The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi 100000, Vietnam.
出版信息
Biomed Res Int. 2020 Nov 21;2020:3701379. doi: 10.1155/2020/3701379. eCollection 2020.
BACKGROUND
HCV testing is an important first step for treatment and prevention, particularly for those who are highly vulnerable to HCV infection such as people who inject drugs (PWID). In settings where direct-acting antiretroviral medicines are becoming more available, limited information exists about who and where to target to increase the prevalence of HCV testing among PWID. This study is aimed at understanding the prevalence of HCV testing uptake and its determinants of medical services and risk behaviors.
METHODS
From February 2016 to April 2017, a sample of 509 PWID was interviewed using a structured questionnaire on their history of HCV testing, confirmation, services using in the previous year as well as HCV-related knowledge, and risk behaviors. Multiple logistic regression identified factors associated with ever being tested for HCV before enrollment in the program.
RESULTS
Approximately 33% reported ever testing for HCV. Most cited sources of testing are public hospitals and general clinics (68.9%) and outpatient clinics (18.9%). Having ever tested for HCV was positively associated with accessing health services within the prior 12 months (aOR = 2.25; 95% CI 1.11-4.58), being currently enrolled in a methadone treatment program (aOR = 2.35; 95% CI 1.34-4.08), and/or on ART treatment (aOR = 2.30; 95% CI 1.30-4.08). Those who ever delayed in seeking healthcare services for any reason were less likely to get tested for HCV (aOR = 0.54; 95% CI 0.35-0.84).
CONCLUSION
HCV testing prevalence is low among PWID in Hanoi despite a very high prevalence of HCV infection. To improve the cascade of HCV testing, it is critical that intervention programs scale up linkages among methadone, outpatient clinics, and HCV services, take steps to reduce stigma and discrimination in both community and, especially, in health care settings, and increase awareness of HCV for PWID by integrating HCV into routine counseling at health care services.
背景
HCV 检测是治疗和预防的重要第一步，特别是对于那些极易感染 HCV 的人群，如注射毒品者（PWID）。在直接作用抗病毒药物越来越普及的环境下，关于针对哪些人以及在何处进行检测以提高 PWID 中 HCV 检测的流行率，相关信息有限。本研究旨在了解 HCV 检测的普及程度及其在医疗服务和风险行为方面的决定因素。
方法
2016 年 2 月至 2017 年 4 月，采用结构化问卷对 509 名 PWID 进行访谈，内容包括 HCV 检测、确诊、前一年使用的服务以及 HCV 相关知识和风险行为。多因素逻辑回归确定了在参加该项目之前曾接受过 HCV 检测的相关因素。
结果
约 33%的人报告曾接受过 HCV 检测。最常提到的检测来源是公立医院和普通诊所（68.9%）和门诊诊所（18.9%）。在过去 12 个月内曾接受过 HCV 检测与在过去 12 个月内获得卫生服务（优势比[aOR] = 2.25；95%置信区间[CI] 1.11-4.58）、当前参加美沙酮治疗计划（aOR = 2.35；95% CI 1.34-4.08）和/或接受 ART 治疗（aOR = 2.30；95% CI 1.30-4.08）呈正相关。因任何原因延迟寻求医疗服务的人更不可能接受 HCV 检测（aOR = 0.54；95% CI 0.35-0.84）。
结论
尽管 HCV 感染率很高，但在河内的 PWID 中 HCV 检测的普及程度仍然很低。为了提高 HCV 检测的连续率，干预计划必须扩大美沙酮、门诊和 HCV 服务之间的联系，采取措施减少社区中特别是在医疗保健环境中的污名和歧视，并通过将 HCV 纳入医疗保健服务的常规咨询来提高 PWID 对 HCV 的认识。
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