Pharmacist-led HIV and hepatitis C point-of-care testing and risk mitigation counseling in individuals experiencing homelessness.
Pharmacist-led HIV and hepatitis C point-of-care testing and risk mitigation counseling in individuals experiencing homelessness.
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DOI：
10.1016/j.rcsop.2021.100007
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Mckeirnan, Kimberly C.
中科院分区：
文献类型：
--
作者：
Kherghehpoush, Sorosh;Mckeirnan, Kimberly C.
在美国，每晚都有超过 50 万人无家可归。由于接触疾病、暴力、耻辱、药物滥用和获得医疗服务的机会有限，无家可归者尤其容易受到艾滋病毒和丙型肝炎等传染病的影响，患病率估计分别高达 21% 和 36%。药剂师是最值得信赖和最容易获得的医疗保健提供者之一，他们处于独特的地位，可以通过提供预防性检测服务和以患者为中心的风险缓解咨询和教育，对“结束艾滋病毒流行：美国计划”和“国家病毒性肝炎计划”的全国性举措产生重大影响。这项研究旨在评估与药剂师主导的艾滋病毒和丙肝病毒筛查以及对无家可归的成年人进行全面教育和风险缓解咨询相关的健康影响。这项研究是在华盛顿州斯波坎的一家独立社区药房进行的，该药房专门提供心理健康服务，为大部分无家可归的患者提供服务。研究参与者是药房的预约患者，年龄超过 18 岁，目前无家可归，并且在过去 6 个月内未接受过 HIV 或 HCV 筛查。研究干预包括风险确定访谈、HIV 和 HCV 现场抗体检测、全面的疾病状态教育和个性化风险缓解咨询。然后，参与者被转介到当地卫生诊所进行确认测试、匿名合作伙伴通知，并在有需要时评估暴露前预防。最终数据分析中共有 10 名参与者。大多数研究参与者是男性 (80%)、异性恋 (90%) 和 30 岁以上 (90%)。共有 8 名参与者 (80%) 进行了反应性 HCV 筛查，但没有进行反应性 HIV 筛查。许多参与者报告了静脉注射毒品的情况，其中甲基苯丙胺是最常用的非法物质。一半的参与者 (50%) 承认在过去 6 个月内借用针头注射毒品。两名参与者承认与已知 HCV 阳性的伴侣发生过性行为，并且两名参与者都进行了反应性 HCV 筛查。所有研究参与者都报告了至少一种严重的精神疾病诊断，并且持续使用娱乐性药物被认为是所有参与者的应对机制。由于治疗效果不再是根除丙型肝炎病毒和抑制艾滋病毒病毒载量的限制因素，因此公共卫生工作需要重新关注患者参与，在比传统检测场所（例如社区药房）污名化的环境中提供预防性服务。研究参与者非常接受社区药房药剂师提供的护理点筛查服务。将艾滋病毒和丙型肝炎护理点检测与以患者为中心的全面教育和风险缓解咨询相结合，可能会降低社区传播率，改善与护理的联系，并可能导致边缘化人群（例如无家可归者）的长期保留。
Over half a million people experience homelessness on any given night in the United States. As a result of increased exposure to disease, violence, stigma, substance misuse and limited accessibility to health services, individuals experiencing homelessness are disproportionately affected by communicable diseases such as HIV and HCV with prevalence estimates as high as 21% and 36%, respectively. Pharmacists, being some of the most trusted and accessible healthcare providers, are in a unique position to have a significant impact on the nationwide initiatives in Ending the HIV Epidemic: A Plan for America and the National Viral Hepatitis Plan by offering preventative testing services and patient-centered risk mitigation counseling and education. This research looks to assess the health impacts associated with pharmacist-led HIV and HCV screening coupled with comprehensive education and risk mitigation counseling in adults experiencing homelessness. This study was conducted in a single independent community pharmacy in Spokane, Washington which specializes in mental health services and serves a large proportion of patients who are experiencing homelessness. Study participants are walk-in patients of the pharmacy, over the age of 18, are currently experiencing homelessness, and have not received an HIV or HCV screening within the past 6 months. The study intervention includes a Risk Determination interview, administration of HIV and HCV point-of-care antibody test, comprehensive diseases state education and personalized risk mitigation counseling. Participants are then referred to a local health clinic for confirmatory testing, anonymous partner notification, and evaluation for pre-exposure prophylaxis if indicated. A total of 10 participants were included in the final data analysis. Majority of study participants were male (80%), heterosexual (90%) and over the age 30 (90%). A total of 8 participants (80%) had a reactive HCV screening and there were no reactive HIV screenings. Many of participants reported IV drug use with methamphetamine being the most used illicit substance. Half of all participants (50%) admitted to borrowing a needle for injection drug use within the past 6 months. Two participants admitted to having sexual intercourse with a partner who was known to be HCV-positive and both participants had a reactive HCV screening. All study participants reported at least one serious mental illness diagnosis and ongoing recreational drug use was cited as a coping mechanism in all participants. Since efficacy of treatment is no longer the limiting factor in eradicating HCV and suppressing HIV viral load, public health efforts need to be refocused on patient engagement through preventative services in an environment that is less stigmatized than traditional testing sites, such as community pharmacies. Study participants were highly receptive to pharmacist-provided point-of-care screening services in the community pharmacy. Combining HIV and HCV point-of-care testing with comprehensive patient-centered education and risk mitigation counseling may result in lower rates of community transmission, improve linkage to care and may lead to long-term retention of marginalized populations such as those experiencing homelessness.
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作者：
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通讯作者：
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56.3
作者：
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作者：
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通讯作者：
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DOI：
10.1097/qai.0000000000001634
发表时间：
2018-05-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
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作者：
Springer SA;Di Paola A;Azar MM;Barbour R;Biondi BE;Desabrais M;Lincoln T;Skiest DJ;Altice FL
通讯作者：
Altice FL