Retention in buprenorphine treatment is associated with improved HCV care outcomes
Retention in buprenorphine treatment is associated with improved HCV care outcomes
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DOI：
10.1016/j.jsat.2017.01.015
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发表时间：
2017-04-01
影响因子：
3.9
通讯作者：
Cunningham, C. O.
中科院分区：
文献类型：
--
作者：
Norton, B. L.;Beitin, A.;Cunningham, C. O.
注射毒品的人，其中大多数是阿片类药物依赖者，占美国HCV感染者的大多数。随着全国阿片类药物流行病的展开，“越来越多的人进入医疗系统接受阿片类药物使用障碍的治疗，特别是丁丙诺啡。然而，对接受丁丙诺啡类阿片类药物治疗的患者的HCV护理知之甚少。我们试图确定HCV患病率、级联护理以及患者特征与开始丁丙诺啡治疗的患者完成HCV级联护理里程碑之间的关联。我们审查了2009年1月至2014年1月期间在纽约州布朗克斯的初级保健诊所开始丁丙诺啡治疗的所有患者的电子健康记录。在开始丁丙诺啡治疗的390名患者中，123名被证实患有慢性HCV感染。与实现HCV治疗里程碑相关的唯一患者特征是阿片类药物治疗的保留。保留的患者（与不保留）丁丙诺啡治疗更有可能被转诊接受丙型肝炎病毒专科护理（63.1% vs. 34.0%，p < 0.01），实现HCV特异性评价（40.8%对21.3%，p < 0.05），被提供HCV治疗（22.4%对8.5%，p < 0.05），和开始HCV治疗（9.2%对6.4%，p = 0.6）。鉴于美国目前阿片类药物流行，以及越来越多的人接受丁丙诺啡治疗，有一个前所未有的机会来接触和治疗HCV感染者，减少HCV传播，发病率和死亡率。保留阿片类药物治疗可以改善HCV护理的联系和保留;将阿片类药物治疗与HCV治疗相结合的创新护理模式至关重要。(C)2017爱思唯尔公司All rights reserved.
Persons who inject drugs, most of whom are opioid dependent, comprise the majority of the HCV infected in the United States. As the national opioid epidemic unfolds,"increasing numbers of people are entering the medical system to access treatment for opioid use disorder, specifically with buprenorphine. Yet little is known about HCV care in patients accessing buprenorphine-based opioid treatment. We sought to determine the HCV prevalence, cascade of care, and the association between patient characteristics and completion of HCV cascade of care milestones for patients initiating buprenorphine treatment We reviewed electronic health records of all patients who initiated buprenorphine treatment at a primary-care clinic in the Bronx, NY between January 2009 and January 2014. Of the 390 patients who initiated buprenorphine treatment, 123 were confirmed to have chronic HCV infection. The only patient characteristic associated with achieving HCV care milestones was retention in opioid treatment. Patients retained (vs. not retained) in buprenorphine treatment were more likely to be referred for HCV specialty care (63.1% vs. 34.0%, p < 0.01), achieve an HCV-specific evaluation (40.8% vs. 21.3%, p < 0.05), be offered HCV treatment (22.4% vs. 8.5%, p < 0.05), and initiate HCV treatment (9.2% vs. 6.4%, p = 0.6). Given the current opioid epidemic in the US and the growing number of people receiving buprenorphine treatment, there is an unprecedented opportunity to access and treat persons with HCV, reducing HCV transmission, morbidity and mortality. Retention in opioid treatment may improve linkage and retention in HCV care; innovative models of care that integrate opioid drug treatment with HCV treatment are essential. (C) 2017 Elsevier Inc. All rights reserved.