Department of Medicine, Queen Mary Hospital, The University of Hong Kong; State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
Department of Medicine, Queen Mary Hospital, The University of Hong Kong.
Int J Drug Policy. 2024 Oct;132:104568. doi: 10.1016/j.drugpo.2024.104568. Epub 2024 Aug 31.
Although the general seroprevalence of hepatitis C virus (HCV) infection in Hong Kong is <0.5 %, Hong Kong is still striving for HCV elimination owing to barriers in care cascade encompassing linkage-to-care (LTC), treatment initiation and adherence. We aimed to evaluate the feasibility of a pilot model of micro-elimination to strengthen the HCV care cascade for high-risk groups in Hong Kong.
We initiated the pilot Conquering Hepatitis vIa Micro-Elimination (CHIME) program which adopts an integrated care approach involving outreach visits to halfway house or drug rehabilitation centers run by non-governmental organizations. Participants with history of injection drug use (PWID), recreational drug use, or imprisonment were included. We performed point-of-care test for anti-HCV with reflex HCV RNA testing. LTC with government-subsidized direct acting antiviral was provided to viremic participants. We compared the impact on the care cascade with a cohort of HCV patients (17.8 % PWID) under usual care.
396 participants (62.9 % PWID) were screened and 187 (47.2 %) were viremic, of which 29.8 % had cirrhosis. Proportion with LTC, treatment initiation and adherence were 76.5 % and 63.7 %, 90.9 % and 85.8 %, and 90.0 % and 92.2 %, for the CHIME program and usual care, respectively. The CHIME program was significantly associated with higher odds of LTC (OR 1.797, 95 % CI 1.221-2.644). Non-engagement in care (affecting 37.9 % participants with HCV viremia) was associated with unemployment (OR 2.165, 95 % CI 1.118-4.190).
The pilot CHIME program demonstrated feasibility of an integrated approach to consolidate the HCV care cascade in high-risk populations in Hong Kong.
尽管香港的丙型肝炎病毒 (HCV) 感染总血清流行率<0.5%，但由于包括联系治疗（LTC）、治疗开始和坚持在内的护理级联中的障碍，香港仍在努力消除 HCV。我们旨在评估一种强化香港高危人群 HCV 护理级联的试点微消除模式的可行性。
我们启动了试点征服肝炎 vIa 微消除（CHIME）计划，该计划采用综合护理方法，包括对非政府组织运营的中途之家或戒毒康复中心进行外展访问。纳入有注射吸毒史（PWID）、消遣性药物使用或监禁史的参与者。我们对有感染史的参与者进行即时护理抗 HCV 检测，并进行 HCV RNA 检测。为病毒血症参与者提供政府补贴的直接作用抗病毒药物 LTC。我们将该方案的影响与常规护理下的 HCV 患者队列（17.8%的 PWID）进行了比较。
对 396 名参与者（62.9%的 PWID）进行了筛查，其中 187 名（47.2%）为病毒血症，其中 29.8%有肝硬化。LTC、治疗开始和坚持的比例分别为 CHIME 方案和常规护理的 76.5%和 63.7%、90.9%和 85.8%、90.0%和 92.2%。CHIME 方案与 LTC 的高几率显著相关（OR 1.797，95%CI 1.221-2.644）。非参与护理（影响 37.9%的 HCV 病毒血症患者）与失业相关（OR 2.165，95%CI 1.118-4.190）。
试点 CHIME 计划证明了在香港高危人群中采用综合方法巩固 HCV 护理级联的可行性。
