Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services.
Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services.
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单一卫生系统内的丙型肝炎：当与具有嵌入式支持服务的诊所联系时，对于那些滥用药物的人来说，沿着级联治愈的进展更快。
DOI：
10.1093/ofid/ofy202
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发表时间：
2018
影响因子：
4.2
通讯作者：
Dillingham,R
中科院分区：
文献类型：
--
作者：
Sherbuk,JE;McManus,KA;RogawskiMcQuade,ET;Knick,T;Henry,Z;Dillingham,R
背景丙型肝炎现在对大多数人来说是可以治愈的，并且已经建立了消除丙型肝炎的国家目标。然而，传播仍然存在，特别是在受类阿片流行病影响的非城市地区。为了达到消除的目标，治疗的障碍必须identified.MethodsIn这个开放队列的所有个人诊断为活动性丙型肝炎，从2010年至2016年在一个大型医疗中心，我们确定了患者和临床特征与我们的主要结果，持续病毒学应答（SVR）。我们进行了亚组分析，为那些有记录的物质missions.ResultsSVR达到1544（41%）的3790人与活动性丙型肝炎。在多变量Poisson回归模型中，SVR更可能发生在门诊诊断的个体中（发病率比[IRR]，1.7; 95%置信区间[CI]，1.5-2.0），居住在医疗中心附近（IRR，1.2; 95% CI，1.1-1.3），有私人保险（IRR，1.1; 95% CI，1.0-1.3），肝硬化（IRR，1.4; 95% CI，1.3-1.5）。贫困（IRR，0.8; 95% CI，0.8-0.9）和药物滥用（IRR，0.8; 95% CI，0.7-0.9）患者实现SVR的可能性较小。在那些物质滥用的亚组分析，SVR率较高，在那些与传染病诊所，其中有嵌入式的支持服务，比那些与胃肠病诊所，这并不（IRR，1.4; 95%CI，1.1-1.9）。药物滥用者是治疗丙型肝炎的高优先级人群，在具有嵌入式支持服务的诊所接受护理时，结果更好。
BackgroundHepatitis C is now curable for most individuals, and national goals for elimination have been established. Transmission persists, however, particularly in nonurban regions affected by the opioid epidemic. To reach goals of elimination, barriers to treatment must be identified.MethodsIn this open cohort of all individuals diagnosed with active hepatitis C from 2010 to 2016 at a large medical center, we identified patient and clinic characteristics associated with our primary outcome, sustained virologic response (SVR). We performed a subgroup analysis for those with documented substance misuse.ResultsSVR was achieved in 1544 (41%) of 3790 people with active hepatitis C. In a multivariable Poisson regression model, SVR was more likely in individuals diagnosed outpatient (incident rate ratio [IRR], 1.7; 95% confidence interval [CI], 1.5–2.0), living in close proximity to the medical center (IRR, 1.2; 95% CI, 1.1–1.3), with private insurance (IRR, 1.1; 95% CI, 1.0–1.3), and with cirrhosis (IRR, 1.4; 95% CI, 1.3–1.5). Achieving SVR was less likely in those qualifying as indigent (IRR, 0.8; 95% CI, 0.8–0.9) and those with substance misuse (IRR, 0.8; 95% CI, 0.7–0.9). In the subgroup analysis of those with substance misuse, SVR rates were higher in those linked to the infectious diseases clinic, which has embedded support services, than those linked to the gastroenterology clinic, which does not (IRR, 1.4; 95% CI, 1.1–1.9).ConclusionsSocial determinants of health including proximity to care and poverty impacted achievement of SVR. Those with substance misuse, a high-priority population for treatment of hepatitis C, had better outcomes when receiving care in a clinic with embedded support services.