Peer outreach point-of-care testing as a bridge to hepatitis C care for people who inject drugs in Toronto, Canada
Peer outreach point-of-care testing as a bridge to hepatitis C care for people who inject drugs in Toronto, Canada
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DOI：
10.1016/j.drugpo.2020.102755
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发表时间：
2020-06-01
影响因子：
4.4
通讯作者：
Powis, Jeff
中科院分区：
文献类型：
--
作者：
Broad, Jennifer;Mason, Kate;Powis, Jeff
背景：注射吸毒者丙型肝炎（HCV）发病率很高，但许多人仍未得到诊断和治疗。丙型肝炎病毒治疗指南和消除战略建议转移任务，以扩大在何处、由谁提供丙型肝炎病毒检测和护理。方法：采用随机对照试验设计来评估卫生和社会服务场所以外的同伴外展工作者在护理点（POC）进行HCV抗体检测是否会提高HCV护理的参与度。有终生注射药物使用史但事先不知道HCV抗体状况的人随机接受HCV外展加POC或转介到社区HCV项目进行常规检测。该研究是由有丙型肝炎生活经历的人共同设计的。结果：在14周的时间里，920人参与了研究。在拒绝、退出和删除重复实验后，共有380名研究参与者。推广活动主要在公共场所（66%）进行，如公园、咖啡店和公寓大堂。与会者报告说，贫困率非常高，住房不稳定，最近注射吸毒。尽管他们是HCV的高危人群，61%的人没有HCV检测的历史或知识（n = 230）。在接受POC检测的患者中，77/195 (39%)HCV抗体阳性。接受POC治疗的患者（n = 6; 3%）与未接受POC治疗的患者（n = 5; 3%）相比，HCV治疗的参与率没有变化。结论：同伴外展工作者能够有效地接触到HCV抗体高流行率和先前HCV检测率低的边缘人群。这提高了参与者对其HCV抗体状态的了解，但这种了解本身并没有导致参与者随后参与HCV治疗的任何变化。未来的工作需要评估诸如激励或同伴导航等策略，以改善诊断后与HCV护理的联系。
Background: People who inject drugs have high rates of hepatitis C (HCV) and yet many remain undiagnosed and untreated. HCV treatment guidelines and elimination strategies recommend task-shifting to expand where, and by whom, HCV testing and care is delivered.Methods: A randomized controlled trial design was used to evaluate if point-of-care (POC) HCV antibody testing by peer outreach workers outside of health and social service spaces would improve engagement in HCV care. People with a lifetime history of injection drug use without prior knowledge of HCV antibody status were randomized to receive HCV outreach plus either POC or referral to community-based HCV program for testing as usual. The study was co-designed by people with lived experience of HCV.Results: 920 people were approached to participate over 14 weeks. After refusals, withdrawals and removal of duplicates, there were 380 study participants. Outreach took place primarily in public spaces (66%) such as parks, coffee shops and apartment lobbies. Participants reported very high rates of poverty, housing instability and recent injection drug use. Despite being at high risk for HCV, 61% had no history or knowledge of past HCV testing (n = 230). Of those who received a POC test 77/195 (39%) were positive for HCV antibodies. There was no change in rates of engagement in HCV care among those who received the POC (n = 6; 3%) compared to those who did not (n = 5; 3%).Conclusion: Peer outreach workers were able to efficiently reach a marginalized group of individuals who had a high HCV antibody prevalence and low rates of prior HCV testing. This improved participants' knowledge of their HCV antibody status, but that knowledge in itself did not lead to any change in participant's subsequent engagement in HCV care. Future work is required to evaluate strategies such as incentives or peer navigators to improve linkage to HCV care after diagnosis.