Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Am J Emerg Med. 2022 Jun;56:151-157. doi: 10.1016/j.ajem.2022.03.041. Epub 2022 Mar 24.
Emergency department (ED) hepatitis C virus (HCV) screening programs are proliferating, and it is unknown whether EDs are more effective than traditional community screening at promoting HCV follow-up care. The objective of this study was to investigate whether patients screened HCV seropositive (HCV+) in the ED are linked to care and retained in treatment more successfully than patients screened HCV+ in the community.
A retrospective cohort study was performed including patients screened HCV+ at twelve screening facilities in New Orleans, LA from March 1, 2015 to July 31, 2017. Treatment outcomes, including retention and time to follow-up care, were assessed using the HCV continuum of care model.
ED patients (n = 3008) were significantly more likely to achieve RNA confirmation (aRR = 1.91, 95% CI = 1.54-2.37), initiate HCV therapy (aRR = 2.23 [1.76-2.83]), complete HCV therapy (aRR = 1.77 [1.40-2.24]), and achieve HCV functional cure (aRR = 2.80 [1.09-7.23]) compared to community-screened patients (n = 322). ED screening was associated with decreased likelihood of fibrosis staging (aRR = 0.65 [0.51-0.82]) and no difference in linkage to specialty care (aRR = 1.03 [0.69-1.53]). In time to follow up, RNA confirmation occurred at faster rates in the ED (aHR = 2.26 [1.86-2.72]), although these patients completed fibrosis staging at slower rates (aHR = 0.49 [0.38-0.63]) than community patients.
Compared to community screening, HCV screening in the ED was associated with higher rates of disease confirmation, treatment initiation/completion, and cure. Our findings provide new evidence that EDs may be the most effective setting to screen patients for HCV to promote follow-up care.
急诊部门（ED）丙型肝炎病毒（HCV）筛查项目正在迅速增加，尚不清楚 ED 是否比传统社区筛查更能有效地促进 HCV 随访护理。本研究的目的是调查在 ED 筛查出 HCV 血清阳性（HCV+）的患者是否比在社区筛查出 HCV+的患者更成功地获得护理并保留在治疗中。
这是一项回顾性队列研究，纳入了 2015 年 3 月 1 日至 2017 年 7 月 31 日期间在路易斯安那州新奥尔良的 12 个筛查点筛查出 HCV+的患者。使用 HCV 护理连续性模型评估治疗结局，包括保留和随访护理时间。
ED 患者（n=3008）与社区筛查的患者（n=322）相比，更有可能进行 RNA 确认（aRR=1.91，95%CI=1.54-2.37）、开始 HCV 治疗（aRR=2.23[1.76-2.83]）、完成 HCV 治疗（aRR=1.77[1.40-2.24]）和实现 HCV 功能性治愈（aRR=2.80[1.09-7.23]）。ED 筛查与较低的纤维化分期（aRR=0.65[0.51-0.82]）相关，与专科护理的联系无差异（aRR=1.03[0.69-1.53]）。在随访时间方面，ED 患者的 RNA 确认速度更快（aHR=2.26[1.86-2.72]），尽管这些患者的纤维化分期速度较慢（aHR=0.49[0.38-0.63]）。
与社区筛查相比，ED 中的 HCV 筛查与更高的疾病确认率、治疗开始/完成率和治愈率相关。我们的研究结果提供了新的证据，表明 ED 可能是筛查 HCV 以促进随访护理的最有效场所。
