Simultaneous Human Immunodeficiency Virus-Hepatitis B-Hepatitis C Point-of-Care Tests Improve Outcomes in Linkage-to-Care: Results of a Randomized Control Trial in Persons Without Healthcare Coverage.
Simultaneous Human Immunodeficiency Virus-Hepatitis B-Hepatitis C Point-of-Care Tests Improve Outcomes in Linkage-to-Care: Results of a Randomized Control Trial in Persons Without Healthcare Coverage.
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同时进行的人类免疫缺陷病毒 - 肝炎B-肝炎C护理点测试改善了连锁到护理的预后：在没有医疗保健覆盖的人中进行随机控制试验的结果。
DOI：
10.1093/ofid/ofv162
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发表时间：
2015-12
影响因子：
4.2
通讯作者：
Lacombe K
中科院分区：
文献类型：
--
作者：
Bottero J;Boyd A;Gozlan J;Carrat F;Nau J;Pauti MD;Rougier H;Girard PM;Lacombe K
在这项随机对照试验中，在法国的一家免费诊所进行，主要针对没有医疗保健的移民人群，我们证明了同时进行HIV/HBV/HCV即时快速检测可以改善筛查结果。提高对感染状况的认识可能有助于将这些患者与护理联系起来。背景：在欧洲和美国，超过三分之二的感染B型肝炎病毒（HBV）或丙型肝炎病毒（HCV）的个体和15%-30%的人类免疫缺陷病毒（HIV）阳性个体不知道自己的感染状况。 同时进行HIV、HBV和HCV快速检测有助于提高特别脆弱人群的感染意识和与护理的联系。方法：OptiScreen III研究是一项在免费诊所（“Médecins du Monde”，巴黎，法国）进行的单中心、随机、对照试验。 参与者以1：1的比例随机接受2种HIV、HBV和HCV检测干预措施之一：标准血清学检测（S组）或即时快速检测（RT组）。主要的研究终点是参与者的比例，他们意识到自己的HIV，HBV和HCV状态，并且在检测呈阳性时与护理有关。结果：总共有324人，主要代表非洲移民，被包括在内。 在S组中，162名参与者中有115名（71.0%）进行了抽血，162名参与者中有104名（64.2%）检索了他们的检测结果。相比之下，随机分配到RT组的162名参与者中有159名（98.2%）获得了结果（P < .001）。在38例（11.7%）检测阳性的参与者中（HIV，n = 7; HBV，n = 23; HCV，n = 8），S组18例中的15例（83.3%）和RT组20例中的18例（90.0%）与护理相关（P = 0.7）。在事后分析中，假设未获得检测结果的患者的疾病患病率相同，与护理相关的差异更明显（S组= 60.0% vs RT组= 90.0%; P = 0.04）。结论：在慢性病毒感染的高危人群中，同时使用HIV、HBV和HCV床旁检测明显改善了“级联筛查”，很可能与护理联系在一起。
In this randomized-control trial, conducted at a free clinic in France for predominately immigrant populations without healthcare, we demonstrate that simultaneous HIV/HBV/HCV point-of-care rapid testing improves screening outcomes. Increased awareness of infection status likely helped link these patients to care. Background. In Europe and the United States, more than two thirds of individuals infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and 15%–30% of human immunodeficiency virus (HIV)-positive individuals are unaware of their infection status. Simultaneous HIV-, HBV-, and HCV-rapid tests could help improve infection awareness and linkage-to-care in particularly vulnerable populations. Methods. The OptiScreen III study was a single-center, randomized, control trial conducted at a free clinic (“Médecins du Monde”, Paris, France). Participants were randomized 1:1 to receive 1 of 2 interventions testing for HIV, HBV, and HCV: standard serology-based testing (S-arm) or point-of-care rapid testing (RT-arm). The main study endpoints were the proportion of participants who became aware of their HIV, HBV, and HCV status and who were linked to care when testing positive. Results. A total of 324 individuals, representing mainly African immigrants, were included. In the S-arm, 115 of 162 (71.0%) participants performed a blood draw and 104 of 162 (64.2%) retrieved their test result. In comparison, 159 of 162 (98.2%) of participants randomized to the RT-arm obtained their results (P < .001). Of the 38 (11.7%) participants testing positive (HIV, n = 7; HBV, n = 23; HCV, n = 8), 15 of 18 (83.3%) in the S-arm and 18 of 20 (90.0%) in the RT-arm were linked-to-care (P = .7). In post hoc analysis assuming the same disease prevalence in those without obtaining test results, difference in linkage-to-care was more pronounced (S-arm = 60.0% vs RT-arm = 90.0%; P = .04). Conclusions. In a highly at-risk population for chronic viral infections, the simultaneous use of HIV, HBV, and HCV point-of-care tests clearly improves the “cascade of screening” and quite possibly linkage-to-care.