开发乙型和丙型肝炎病毒携带者的衔接治疗和随访干预系统。

Development of an intervention system for linkage-to-care and follow-up for hepatitis B and C virus carriers.

机构信息

Department of Virology II, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.

Department of Molecular Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan.

出版信息

Hepatol Int. 2022 Feb;16(1):68-80. doi: 10.1007/s12072-021-10269-5. Epub 2021 Dec 2.

DOI:10.1007/s12072-021-10269-5

PMID:34855104

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8636575/

Abstract

BACKGROUND

Poor connections in the cascade of viral hepatitis care have been discussed around the world. In 2011 in Japan, 500,000 to 1.25 million hepatitis B and C virus carriers needed to consult with hepatologists, so linkage-to-care (LTC) needs to be promoted. Therefore, in this study, to improve LTC and care-seeking behaviors, we attempted to establish a community-based intervention system and evaluate its effectiveness by analyzing behavior modifications.

METHODS

In a model city, Okazaki (population: 387,887 as of 2019), LTC was encouraged among HBV and HCV carriers by annually mailed brochures, and their care-seeking behaviors were followed up through questionnaires for 8 years (2012-2019). Their behavior modifications and demographic characteristics were analyzed anonymously in cooperation with community health workers, hepatologists, and researchers.

RESULTS

Through regional HBsAg and anti-HCV screening, 333 HBV and 208 HCV carriers were identified. Before the intervention, only 34.7% (25/72) of HBV- and 34.3% (24/70) of HCV-positive individuals had consulted with hepatologists. However, in 2019, after the intervention, these proportions increased to 79.8% (91/114) and 91.2% (52/57), respectively. Access to outpatient care and treatment uptake also continuously improved. However, individuals over 70 years of age were significantly less likely to engage in care-seeking behaviors (p < 0.05), and significantly fewer HCV-positive females received treatment (p = 0.03).

CONCLUSIONS

A paper-based reiterative intervention encouraging LTC and follow-up successfully improved the care-seeking behaviors of hepatitis virus-positive individuals and enabled their behavior modifications to be monitored. Further trials are required to advance the system by age- and gender-specific interventions.

摘要

背景

世界各地都讨论了在病毒性肝炎治疗过程中连接不良的问题。2011 年在日本，有 50 万至 125 万乙型肝炎和丙型肝炎病毒携带者需要咨询肝病专家，因此需要促进患者与医护人员的联系（LTC）。因此，在这项研究中，为了改善 LTC 和寻求医疗服务的行为，我们试图建立一个基于社区的干预系统，并通过分析行为改变来评估其效果。

方法

在一个示范城市（2019 年人口为 387887 人），我们通过每年邮寄宣传册来鼓励 HBV 和 HCV 携带者进行 LTC，并通过问卷调查对他们的医疗服务需求进行了 8 年（2012-2019 年）的跟踪调查。我们匿名与社区卫生工作者、肝病专家和研究人员合作，分析他们的行为改变和人口统计学特征。

结果

通过区域 HBsAg 和抗 HCV 筛查，发现 333 名 HBV 和 208 名 HCV 携带者。在干预之前，只有 34.7%（25/72）的 HBV-和 34.3%（24/70）的 HCV 阳性个体曾咨询过肝病专家。然而，在 2019 年干预后，这一比例分别增加到 79.8%（91/114）和 91.2%（52/57）。门诊服务的可及性和治疗的接受率也在不断提高。然而，70 岁以上的个体参与医疗服务需求的可能性显著降低（p<0.05），且显著较少的 HCV 阳性女性接受治疗（p=0.03）。