Hepatitis C treatment outcomes among homeless-experienced individuals at a community health centre in Boston
Hepatitis C treatment outcomes among homeless-experienced individuals at a community health centre in Boston
复制标题
DOI：
10.1016/j.drugpo.2019.03.017
复制
发表时间：
2019-10-01
影响因子：
4.4
通讯作者：
Baggett, Travis P.
中科院分区：
文献类型：
--
作者：
Beiser, Marguerite E.;Smith, Kamala;Baggett, Travis P.
背景：在无家可归的成年人中，丙型肝炎病毒（HCV）感染率很高，但这一人群中丙型肝炎病毒治疗结果的数据有限。我们在美国马萨诸塞州波士顿的一个创新的社区初级保健项目中检查了一组无家可归的有经验的成年人的HCV治疗参与和结果。方法：我们对2014年1月至2017年3月在波士顿无家可归者卫生保健计划（BHCHP）转诊接受HCV治疗的个体进行了回顾性图表回顾。我们评估了HCV治疗开始、治疗完成、持续病毒学反应（SVR）和再感染率。我们进行了单变量和多变量逻辑回归分析来检验这些结果的预测因子。结果：在510例HCV治疗中，210例（41.1%）没有开始治疗，主要是因为失去随访（N = 93）或有替代的社会问题（N = 49）。在300名开始治疗的患者中，80%为男性，52.3%为非白人，29%为无家可归者。超过一半（58.6%）有阿片类药物使用障碍（OUD）史。20%患有肝硬化。285例（95.0%）完成治疗，255例（85.0%）达到SVR。在多变量分析中，双相情感障碍（OR 0.38, 95% CI 0.15 - 0.99）、治疗过（OR 0.36, 95% CI 0.14 - 0.96）或未治疗过（OR 0.18, 95% CI 0.05 - 0.57）、OUD或治疗保险变更（OR 0.16, 95% CI 0.04 - 0.67）的个体实现SVR的可能性较小，而艾滋病毒感染者（OR 10.43, 95% CI 1.33-81.96）实现SVR的可能性更大。在126名有svr后随访数据的患者中，在206人-年的随访中发现了27例再感染（比率为13.1 / 100人-年）。结论：有经验的无家可归者在社区项目中开始HCV治疗，获得了很高的治疗完成率和SVR，但很大一部分人没有开始治疗。OUD患者的治愈率虽低，但仍相当可观。针对有无家可归经验的人的治疗策略应侧重于改善初始参与并尽量减少治疗后的再感染风险。
Background: Hepatitis C virus (HCV) infection prevalence is high among adults who experience homelessness but data on HCV treatment outcomes are limited in this population. We examined HCV treatment engagement and outcomes in a cohort of homeless-experienced adults treated through an innovative community-based primary care program in Boston, Massachusetts, USA.Methods: We conducted a retrospective chart review of individuals referred for HCV treatment at Boston Health Care for the Homeless Program (BHCHP) from January 2014 to March 2017. We assessed HCV treatment initiation, treatment completion, sustained virologic response (SVR), and reinfection rates. We conducted univariate and multivariable logistic regression analyses to examine the predictors of these outcomes.Results: Of 510 referred for HCV treatment, 210 (41.1%) did not initiate treatment, principally because of being lost to follow-up (N = 93) or having superseding social issues (N = 49). Of 300 who initiated treatment, 80% were male, 52.3% were non-white, and 29% were homeless. Over half (58.6%) had a history of opioid use disorder (OUD). Twenty percent had cirrhosis. Treatment was completed by 285 (95.0%) individuals, and 255 (85.0%) achieved SVR. In multivariable analyses, individuals with bipolar disorder (OR 0.38, 95% CI 0.15 - 0.99), treated (OR 0.36, 95% CI 0.14 - 0.96) or untreated (OR 0.18, 95% CI 0.05 - 0.57) OUD, or ontreatment insurance change (OR 0.16, 95% CI 0.04 - 0.67) were less likely to achieve SVR, while individuals living with HIV (OR 10.43, 95% CI 1.33-81.96) were more likely to achieve SVR. Among 126 individuals with post-SVR follow-up data, 27 reinfection were identified during 206 person-years of follow up (rate 13.1 per 100 person-years).Conclusion: Homeless-experienced individuals initiating HCV treatment in a community-based program achieved high rates of treatment completion and SVR, but a large proportion did not initiate treatment. Individuals with OUD experienced lower but still substantial rates of cure. Treatment strategies targeting homeless-experienced people should focus on improving initial engagement and minimizing reinfection risk following treatment.