社区监管场所开展丙型肝炎病毒检测和转介的可行性：潜力巨大，但挑战持续存在。
Feasibility of hepatitis C virus testing and linkage in community supervision offices: Great potential but persistent challenges.
机构信息
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA.
出版信息
Int J Drug Policy. 2022 May;103:103668. doi: 10.1016/j.drugpo.2022.103668. Epub 2022 Mar 31.
BACKGROUND
Persons involved with the justice system have an elevated risk of hepatitis C virus (HCV) yet remain marginalized from treatment. Efforts to eliminate HCV will require targeted interventions within the justice system effective at providing diagnosis and treatment.
METHODS
We implemented a novel HCV screening and treatment intervention for persons under community supervision in Rhode Island, USA during April 2018--March 2020. Participants received rapid point-of-care HCV antibody testing onsite and referral to community laboratory and treatment services as indicated. We assessed the HCV care cascade to identify areas for improvement.
RESULTS
Overall, 483 individuals were screened for HCV antibody; 85 (18%) were positive. A minority of participants with positive HCV antibody tests (n=25/85, 29%) presented to community laboratories for confirmatory testing. Among participants that received HCV viral load results and linked to a treatment provider (n=12), four initiated treatment, three had record of completing treatment, and two were confirmed to have achieved cure.
CONCLUSION
Linkage to HCV viral load testing and treatment was challenging in this community supervision population, with substantial loss to follow-up at each step of the HCV cascade. Community supervision remains an important venue for case identification but substantial barriers to accessing HCV treatment exist. Innovative HCV diagnosis and treatment strategies are needed for community supervision populations.
背景
参与司法系统的人感染丙型肝炎病毒（HCV）的风险较高，但仍被排除在治疗之外。消除 HCV 需要在司法系统内采取有针对性的干预措施，有效地提供诊断和治疗。
方法
我们在美国罗德岛州实施了一项针对社区监管下人员的新型 HCV 筛查和治疗干预措施，时间为 2018 年 4 月至 2020 年 3 月。参与者接受现场即时 HCV 抗体检测，并根据需要转介到社区实验室和治疗服务。我们评估了 HCV 护理流程，以确定需要改进的领域。
结果
总体而言，有 483 人接受了 HCV 抗体筛查；85 人（18%）呈阳性。少数 HCV 抗体检测阳性的参与者（n=25/85，29%）到社区实验室进行确认检测。在接受 HCV 病毒载量检测并与治疗提供者联系的参与者中（n=12），有 4 人开始接受治疗，3 人完成了治疗，2 人被确认已治愈。
结论
在社区监管人群中，与 HCV 病毒载量检测和治疗相关联具有挑战性，在 HCV 级联的每个步骤都有大量的失访。社区监管仍然是病例识别的重要场所，但存在着大量获得 HCV 治疗的障碍。需要为社区监管人群制定创新的 HCV 诊断和治疗策略。
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