Papaluca Timothy, Craigie Anne, McDonald Lucy, Edwards Amy, Winter Rebecca, Hoang Annabelle, Pappas Alex, Waldron Aoife, McCoy Kelsey, Stoove Mark, Doyle Joseph, Hellard Margaret, Holmes Jacinta, MacIsaac Michael, Desmond Paul, Iser David, Thompson Alexander J
Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
Burnet Institute, The University of Melbourne, Melbourne, Victoria, Australia.
Open Forum Infect Dis. 2022 Jul 28;9(8):ofac350. doi: 10.1093/ofid/ofac350. eCollection 2022 Aug.
Prison-based hepatitis C treatment is safe and effective; however, many individuals are released untreated due to time or resource constraints. On community re-entry, individuals face a number of immediate competing priorities, and in this context, linkage to hepatitis C care is low. Interventions targeted at improving healthcare continuity after prison release have yielded positive outcomes for other health diagnoses; however, data regarding hepatitis C transitional care are limited.
We conducted a prospective randomized controlled trial comparing a hepatitis C care navigator intervention with standard of care for individuals released from prison with untreated hepatitis C infection. The primary outcome was prescription of hepatitis C direct-acting antivirals (DAA) within 6 months of release.
Forty-six participants were randomized. The median age was 36 years and 59% were male. Ninety percent ( = 36 of 40) had injected drugs within 6 months before incarceration. Twenty-two were randomized to care navigation and 24 were randomized to standard of care. Individuals randomized to the intervention were more likely to commence hepatitis C DAAs within 6 months of release (73%, = 16 of 22 vs 33% = 8 of 24, < .01), and the median time between re-entry and DAA prescription was significantly shorter (21 days [interquartile range {IQR}, 11-42] vs 82 days [IQR, 44-99], = .049).
Care navigation increased hepatitis C treatment uptake among untreated individuals released from prison. Public policy should support similar models of care to promote treatment in this high-risk population. Such an approach will help achieve hepatitis C elimination as a public health threat.
基于监狱的丙型肝炎治疗是安全有效的；然而，由于时间或资源限制，许多患者未接受治疗便被释放。重返社区后，这些人面临着一系列亟待解决的优先事项，在此背景下，与丙型肝炎护理的联系率较低。针对改善出狱后医疗连续性的干预措施已在其他健康诊断方面取得了积极成果；然而，关于丙型肝炎过渡性护理的数据有限。
我们进行了一项前瞻性随机对照试验，比较丙型肝炎护理导航干预与对未接受治疗的丙型肝炎感染出狱人员的标准护理。主要结局是在释放后6个月内开具丙型肝炎直接抗病毒药物（DAA）的处方。
46名参与者被随机分组。中位年龄为36岁，59%为男性。90%（40人中的36人）在入狱前6个月内注射过毒品。22人被随机分配到护理导航组，24人被随机分配到标准护理组。被随机分配到干预组的个体在释放后6个月内开始使用丙型肝炎DAA的可能性更高（73%，22人中的16人，而标准护理组为33%，24人中的8人，P<0.01），重新进入社会与开具DAA处方之间的中位时间明显更短（21天[四分位间距{IQR}，11 - 42] vs 82天[IQR，44 - 99]，P = 0.049）。
护理导航提高了未接受治疗的出狱人员对丙型肝炎治疗的接受度。公共政策应支持类似的护理模式，以促进对这一高危人群的治疗。这种方法将有助于消除丙型肝炎作为一种公共卫生威胁。
