加拿大多伦多一家综合监督下注射服务机构的丙型肝炎病毒即时检测与治疗：一项前瞻性观察队列研究
Rapid hepatitis C virus point-of-care RNA testing and treatment at an integrated supervised consumption service in Toronto, Canada: a prospective, observational cohort study.
作者信息
Lettner Bernadette, Mason Kate, Greenwald Zoë R, Broad Jennifer, Mandel Erin, Feld Jordan J, Powis Jeff
机构信息
South Riverdale Community Health Centre, 955 Queen St E, Toronto, ON, M4M 3P3, Canada.
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
出版信息
Lancet Reg Health Am. 2023 May 17;22:100490. doi: 10.1016/j.lana.2023.100490. eCollection 2023 Jun.
BACKGROUND
Despite high burden of Hepatitis C (HCV) among people who inject drugs, significant barriers to care persist. The aim of this study was to evaluate the provision of rapid, low-barrier point-of-care (POC) HCV RNA testing and linkage to care among clients of a supervised consumption service (SCS) located within a community health centre in Toronto, Canada. Secondary aims included measuring HCV RNA prevalence at baseline, HCV incidence during follow-up and exploring factors associated with HCV RNA positivity and treatment uptake.
METHODS
Participants were enrolled in a prospective, observational cohort from August 13, 2018 to September 30, 2021. Those with positive HCV RNA tests were offered immediate referral to onsite treatment. Those with negative results were offered repeat testing every three months for up to four visits. HCV incidence was estimated as the number of incident HCV infections per 100 person-years at risk, among those HCV RNA negative at baseline who returned for ≥1 follow-up visit. Missing data were reported when present.
FINDINGS
128 participants were enrolled with four later removed due to ineligibility. At baseline, 54 of 124 eligible participants (43.5%) tested HCV RNA positive. HCV incidence was 35.1 cases per 100 person-years (95% CI: 18.9-65.3) with a cumulative incidence of 38.3% at 15 months of follow-up. Among participants HCV RNA positive at baseline or follow-up (n = 64), 67.2% (n = 43) were linked to HCV care and treatment was initiated among 67.4% (n = 29/43).
INTERPRETATION
High HCV RNA prevalence and incidence demonstrate that the SCS serves a high-risk population for HCV. Testing acceptance was high, as was treatment engagement. POC HCV RNA testing positions SCSs as an important point of HCV care access.
FUNDING
HCV Micro-Elimination Grant, Gilead Sciences Canada; in-kind support from Cepheid.
背景
尽管注射吸毒者中丙型肝炎（HCV）负担沉重，但护理方面仍存在重大障碍。本研究的目的是评估在加拿大多伦多一家社区卫生中心内的受监督消费服务（SCS）的客户中提供快速、低障碍的即时护理（POC）HCV RNA检测以及与护理的联系。次要目标包括测量基线时HCV RNA流行率、随访期间HCV发病率以及探索与HCV RNA阳性和治疗接受相关的因素。
方法
参与者于2018年8月13日至2021年9月30日纳入一项前瞻性观察队列。HCV RNA检测呈阳性的参与者被立即转介至现场治疗。结果为阴性的参与者每三个月接受一次重复检测，最多检测四次。HCV发病率估计为每100人年有风险的人群中HCV感染新发病例数，这些人在基线时HCV RNA为阴性且返回进行≥1次随访。如有缺失数据则进行报告。
研究结果
128名参与者入组，后有4名因不符合资格被排除。基线时，124名符合条件的参与者中有54名（43.5%）HCV RNA检测呈阳性。HCV发病率为每100人年35.1例（95%CI：18.9 - 65.3），随访15个月时累积发病率为38.3%。在基线或随访时HCV RNA呈阳性的参与者（n = 64）中，67.2%（n = 43）与HCV护理建立了联系，67.4%（n = 29/43）开始接受治疗。
解读
高HCV RNA流行率和发病率表明SCS服务的是HCV高危人群。检测接受度高，治疗参与度也高。POC HCV RNA检测使SCS成为HCV护理获取的重要点。
资金来源
加拿大吉利德科学公司的HCV微消除赠款；赛沛公司的实物支持。
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