Routine Screening and Linkage to Care for Hepatitis C Virus in an Urban Safety-Net Health System, 2017-2019
Routine Screening and Linkage to Care for Hepatitis C Virus in an Urban Safety-Net Health System, 2017-2019
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DOI：
10.1177/0033354920969179
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发表时间：
2020-11-11
影响因子：
3.3
通讯作者：
Glick, Nancy R.
中科院分区：
文献类型：
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作者：
Hunt, Bijou R.;Ahmed, Christopher;Glick, Nancy R.
目的丙型肝炎病毒(HCV)是威胁美国公众健康的主要病毒。我们描述和评估了芝加哥城市安全网卫生系统中的丙型肝炎病毒筛查和联动医疗计划，包括急诊科、住院和门诊设置。方法西奈卫生系统于2016年9月实施了一项普遍的丙型肝炎病毒筛查计划，为RNA检测结果为丙型肝炎病毒阳性的患者提供患者导航服务(即联动医疗服务)。我们收集了从2017年2月1日到2019年1月31日的患者人口统计特征、风险因素和各种结果的数据(例如，筛查的患者数量、检测结果、新诊断的比例、符合患者导航服务的患者数量以及首次就诊的患者比例)。结果在21018人中，6%(1318/21018)的人丙型肝炎病毒抗体检测阳性，其中68%(878/1293)人的丙型肝炎病毒RNA检测结果为阳性。在这878名患者中，68%出生于1945年至1965年，68%是男性，65%是黑人，19%是拉丁裔，55%是新诊断的，%有资格获得患者导航服务。危险因素包括过去或现在吸毒(53%)、失业(30%)和曾被监禁(21%)。在符合导航服务资格的562名患者中，281名(50%)导航到了影像服务，203名(72%)完成了成像的患者参加了他们的首次医疗预约。结论患者导航对联动成功起着关键作用，但确保患者导航员获得稳定、长期的经济支持是一个挑战。
ObjectiveHepatitis C virus (HCV) is a major threat to public health in the United States. We describe and evaluate an HCV screening and linkage-to-care program, including emergency department, inpatient, and outpatient settings, in an urban safety-net health system in Chicago.MethodsSinai Health System implemented a universal HCV screening program in September 2016 that offered patient navigation services (ie, linkage to care) to patients with a positive result for HCV on an RNA test. We collected data from February 1, 2017, through January 31, 2019, on patient demographic characteristics, risk factors, and various outcomes (eg, number of patients screened, test results, proportions of new diagnoses, number of patients eligible for patient navigation services, and proportion of patients who attended their first medical appointment). We also examined outcomes by patients' knowledge of infection.ResultsOf 21 018 people screened for HCV, 6% (1318/21 018) had positive test results for HCV antibody, 68% (878/1293) of whom had positive HCV RNA test results. Of these 878 patients, 68% were born during 1945-1965, 68% were male, 65% were Black, 19% were Latino, 55% were newly diagnosed, and 64% were eligible for patient navigation services. Risk factors included past or current drug use (53%), unemployment (30%), and ever incarcerated (21%). Of 562 patients eligible for navigation services, 281 (50%) were navigated to imaging services, and 203 (72%) patients who completed imaging attended their first medical appointment.ConclusionPatient navigation played a critical role in linkage success, but securing stable, long-term financial support for patient navigators is a challenge.