Toronto Centre for Liver Disease, University Health Network, Canada.
Corresponding Author: Erin Mandel, MPH, Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, 200 Elizabeth Street 9EB 240, Toronto, ON M5G 2C4 (
J Clin Psychiatry. 2023 Jul 31;84(5):22m14623. doi: 10.4088/JCP.22m14623.
To evaluate uptake of hepatitis C virus (HCV) testing and treatment among psychiatry inpatients at Canada's largest mental health institution, the Centre for Addiction and Mental Health (CAMH). We reviewed medical records for all forensic and long-stay mental health patients from January 2017 to May 2021 to examine rates of HCV testing (antibody and RNA), treatment, and follow-up and completed a logistical regression to identify predictors associated with HCV antibody (Ab) screening among inpatients. Of 1,031 patients, 73% (n = 753) were male, mean age was 44 years (range: 20-92), and mean length of stay was 7.1 months (range: 0 days-24 years). Most, 83% (n = 856), were diagnosed with schizophrenia spectrum disorders. In total, 652/1,031 (63%) of individuals in this cohort received HCV Ab screening. When broken down by admission rather than individual, 570/1,303 (44%) forensic admissions had an associated HCV Ab screening, and 318/1,450 (22%) non-forensic admissions had an associated HCV Ab screening. Individuals admitted to a forensic unit and those diagnosed with schizophrenia or substance use disorders were more likely to undergo HCV Ab screening, while individuals of Asian ethnicity were less likely (all < .05). HCV Ab positivity was 4.9%, and most (84%, n = 27) HCV Ab-positive individuals had subsequent RNA testing, of whom 56% (n = 15) tested HCV RNA positive. Of 15 RNA-positive individuals, 10 initiated treatments, 7 on-site at CAMH and 3 at a local hepatology center. A total of 7 individuals (1 treated by specialists and 6 on-site) achieved sustained virological response or cure. The remaining 3 were lost to follow-up, 2 of whom were treated at the hepatology clinic. Based on the high prevalence of HCV, mental health inpatients should be included in groups for whom universal screening is recommended. Since on-site treatment was more successful than referral to external hepatology specialists, utilizing inpatient admission as an opportunity for HCV screening and treatment should receive more consideration.
为了评估加拿大最大的心理健康机构成瘾与心理健康中心（CAMH）精神病住院患者对丙型肝炎病毒（HCV）检测和治疗的接受程度。我们回顾了 2017 年 1 月至 2021 年 5 月所有法医和长期精神健康患者的病历，以检查 HCV 检测（抗体和 RNA）、治疗和随访的比率，并完成了逻辑回归，以确定与住院患者 HCV 抗体（Ab）筛查相关的预测因素。在 1031 名患者中，73%（n=753）为男性，平均年龄为 44 岁（范围：20-92 岁），平均住院时间为 7.1 个月（范围：0 天-24 年）。大多数患者（83%，n=856）被诊断为精神分裂症谱系障碍。在该队列的 1031 人中，共有 652 人（63%）接受了 HCV Ab 筛查。按入院而非个人划分，1303 名法医入院者中有 570 人（44%）接受了 HCV Ab 筛查，1450 名非法医入院者中有 318 人（22%）接受了 HCV Ab 筛查。被送入法医病房的患者和被诊断为精神分裂症或物质使用障碍的患者更有可能接受 HCV Ab 筛查，而亚裔患者则不太可能（均<.05）。HCV Ab 阳性率为 4.9%，大多数（84%，n=27）HCV Ab 阳性患者随后进行了 RNA 检测，其中 56%（n=15）HCV RNA 检测呈阳性。在 15 名 RNA 阳性患者中，有 10 人接受了治疗，其中 7 人在 CAMH 接受治疗，3 人在当地肝病中心接受治疗。总共 7 人（1 人由专家治疗，6 人在现场）实现了持续病毒学应答或治愈。其余 3 人失访，其中 2 人在肝病诊所接受治疗。鉴于 HCV 的高患病率，精神科住院患者应被纳入建议进行普遍筛查的人群。由于现场治疗比转介给外部肝病专家更成功，因此应更多地考虑利用住院患者入院机会进行 HCV 筛查和治疗。
