提高乙型肝炎、丙型肝炎和丁型肝炎患者的治疗关联率：一项回顾性前瞻性研究。

Enhancing linkage to care for hepatitis B, D, and C patients: A retrospective-prospective study.

机构信息

Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.

Liver Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.

出版信息

Aliment Pharmacol Ther. 2024 Nov;60(10):1308-1314. doi: 10.1111/apt.18227. Epub 2024 Aug 27.

DOI:10.1111/apt.18227

PMID:39192590

Abstract

BACKGROUND

The WHO has set a goal to decrease viral hepatitis-related fatalities by 65% by 2030.

AIMS

To locate and retrieve to care all individuals diagnosed with hepatitis B, D or C, and investigate why they were not linked to appropriate medical management.

METHODS

We conducted a retrospective-prospective search for patients with hepatitis B, D or C virus (HBV, HDV and HCV) infection in the central laboratory database of the Barcelona northern health area (catchment population, 450,000). We reviewed records and contacted candidates for retrieval who were offered a specialist medical visit.

RESULTS

We reviewed records of 3731 patients with viral hepatitis (January 2019-December 2022): 1763 HBsAg+, 69 anti-HDV+ and 1899 HCV-RNA+. Among these, 644 (37%) HBV, 20 (29%) HDV and 1116 (56%) HCV patients were not currently linked to care. The proportion of patients receiving appropriate care was higher in HBV and HDV (p < 0.0001), and a higher percentage of unlinked hepatitis C patients had low life expectancy/comorbidities (39%; p < 0.0001). After implementing the linkage strategy, 254 HBV, 16 HDV and 54 HCV patients were successfully reintegrated into care. Among 1780 patients requiring linkage, 638 (35.8%) had moved to another health area or were missing essential contact data.

CONCLUSIONS

Among patients with viral hepatitis who required appropriate specialist care and were eligible for contact, 64% with HBV, 100% with HDV and 27% with HCV were successfully reintegrated into care. Overall, 324 (47.2%) eligible patients were linked to care, indicating the success of this strategy.

摘要

背景

世界卫生组织设定了一个目标，即在 2030 年前将与病毒性肝炎相关的死亡率降低 65%。

目的

定位并找到所有确诊为乙型肝炎、丙型肝炎或丁型肝炎的患者，调查他们为何未被纳入适当的医疗管理。

方法

我们在巴塞罗那北部卫生区（覆盖人口 45 万）的中心实验室数据库中对乙型肝炎、丙型肝炎或丁型肝炎病毒（HBV、HDV 和 HCV）感染患者进行了回顾性前瞻性搜索。我们查阅了病历，并联系了符合检索条件的患者，为他们提供了专科就诊机会。

结果

我们查阅了 2019 年 1 月至 2022 年 12 月期间 3731 例病毒性肝炎患者的病历：1763 例 HBsAg+，69 例抗-HDV+，1899 例 HCV-RNA+。其中，644 例（37%）HBV、20 例（29%）HDV 和 1116 例（56%）HCV 患者未进行现行治疗。HBV 和 HDV 患者中接受适当治疗的比例更高（p<0.0001），未纳入治疗的丙型肝炎患者中预期寿命较短/合并症较多的比例更高（39%；p<0.0001）。实施纳入策略后，254 例 HBV、16 例 HDV 和 54 例 HCV 患者成功重新纳入治疗。在需要纳入治疗的 1780 例患者中，638 例（35.8%）患者已迁往其他卫生区或关键联系数据缺失。