Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: A comprehensive approach
Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: A comprehensive approach
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DOI：
10.1016/j.drugpo.2007.01.013
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发表时间：
2007-10-01
影响因子：
4.4
通讯作者：
Flanigan, Colleen A.
中科院分区：
文献类型：
--
作者：
Birkhead, Guthrie S.;Klein, Susan J.;Flanigan, Colleen A.
背景资料：纽约州估计有230，000名丙型肝炎病毒（HCV）慢性感染者和约171，500名活跃的注射吸毒者（IDUs）。HCV/HIV合并感染很常见，需要有效满足注射吸毒者需要的服务提供模式。丙型肝炎病毒的战略计划强调integration.Methods：丙型肝炎病毒的预防和护理整合在卫生和人类服务环境，包括艾滋病毒/艾滋病组织和药物治疗方案。支持对注射吸毒者提供全面的HCV服务的其他措施包括报销、临床指南、培训和HCV预防教育。结果：注射吸毒者每年通过减少危害/注射器交换方案和全州范围的注射器获取方案获得500万支注射器。纽约市注射吸毒者中HCV流行率的下降与注射器可用性的改善相吻合。新的护理模式成功地将注射吸毒者在SEPs和药物治疗与保健联系起来。超过7000名患有HCV/HIV合并感染的医疗补助接受者在12个月内与HCV相关的医疗保健接触，并支付了10，547份HCV相关药物的索赔。过渡性个案管理转介戒毒治疗的成功率超过90%。培训和临床指南促进提供者对HCV的了解，并有助于为注射吸毒者提供高质量的HCV护理。2004年，对2570名艾滋病毒患者的图表审查记录了在各种环境中总体上97.4%的HCV状态。新的丙型肝炎病毒监测系统正在运作。尽管取得了这一进展，重大的挑战仍然存在。讨论：一个全面的，公共卫生的方法，使用跨系统的多种战略和动员多个部门，可以提高注射吸毒者获得丙型肝炎病毒的预防和护理。需要采取整体的办法，提供综合服务，包括为HCV和艾滋病毒合并感染的注射吸毒者提供服务。领导、协作和资源至关重要。(C)2007 Elsevier B. V.保留所有权利。
Background: New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration.Methods: HCV prevention and care are integrated within health and human service settings, including HIV/AlDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development.Results: IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain.Discussion: A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential. (C) 2007 Elsevier B.V. All rights reserved.