Hepatitis C Virus seroconversion among persons who inject drugs in relation to primary care physician visiting: The potential role of primary healthcare in a combined approach to Hepatitis C prevention
Hepatitis C Virus seroconversion among persons who inject drugs in relation to primary care physician visiting: The potential role of primary healthcare in a combined approach to Hepatitis C prevention
复制标题
DOI：
10.1016/j.drugpo.2015.04.013
复制
发表时间：
2015-10-01
影响因子：
4.4
通讯作者：
Bruneau, Julie
中科院分区：
文献类型：
--
作者：
Artenie, Andreea Adelina;Roy, Elise;Bruneau, Julie
背景：要显著降低丙型肝炎病毒(丙型肝炎病毒)在注射吸毒者(PWID)中的传播率，需要采取全面的预防措施，包括采取减少危害的措施和与医疗保健相关的干预措施，如丙型肝炎病毒筛查、检测和抗病毒治疗。然而，当纳入综合预防方法时，人们对去初级保健医生(PCP)与PWID中的丙型肝炎病毒感染风险相关的作用知之甚少。这项研究评估了参加针具交换计划(NEP)的PWID患者中PCP就诊与丙型肝炎病毒血清转换的关系。方法：在蒙特利尔(20042013)活动性PWID患者中进行了一项前瞻性队列研究，HEPCO。每隔3个月或6个月安排一次访谈，包括完成面试者管理的问卷调查，并采集血液样本进行丙型肝炎病毒抗体检测。丙型肝炎病毒血清阴性的参与者，在基线时报告NEP出席，并至少有一次随访，有资格参加这项研究。丙型肝炎病毒感染率采用人员-时间法计算。结果：在基线评估中，226名参与者(80.5%的男性；中位年龄：30.6岁)中，37.2%的人报告最近去过初级保健中心。在449.6人年的随访中，79名参与者血清转换为丙型肝炎病毒[发病率：17.6/百人年，95%可信区间：14.0-21.8]。协变量校正分析表明，去初级保健中心就诊与较低的丙型肝炎病毒感染风险相关[调整后危险比：0.54，95%CI：0.31-0.93]。其他独立预测丙型肝炎病毒感染的因素包括住房不稳定、注射可卡因和处方阿片类药物注射。结论：在参加NEP的PWID中，去PCP就诊与较低的丙型肝炎病毒感染风险有关。然而，只有一小部分参与者报告说去过PCP。如果结合综合预防方法，在PWID中加强与PCP接触的努力可能有助于降低丙型肝炎的传播。(C)2015爱思唯尔B.V.保留所有权利。
Background: Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP).Methods: A prospective cohort study, HEPCO, was conducted among active PWID in Montreal (20042013). Interviews scheduled at 3- or 6-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence.Results: At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0-21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% Cl: 0.31-0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection.Conclusion: Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention. (C) 2015 Elsevier B.V. All rights reserved.