Increasing the uptake of hepatitis C virus testing among injecting drug users in specialist drug treatment and prison settings by using dried blood spots for diagnostic testing: a cluster randomized controlled trial
Increasing the uptake of hepatitis C virus testing among injecting drug users in specialist drug treatment and prison settings by using dried blood spots for diagnostic testing: a cluster randomized controlled trial
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DOI：
10.1111/j.1365-2893.2007.00937.x
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发表时间：
2008-04-01
影响因子：
2.5
通讯作者：
Parry, J. V.
中科院分区：
文献类型：
--
作者：
Hickman, M.;McDonald, T.;Parry, J. V.
本研究的目的是评估是否引入干血斑检测可以增加丙型肝炎病毒（HCV）的诊断检测。采用整群随机对照试验。将研究中心配对，每对中的一个研究中心随机分配接受干预（培训和使用干血斑）。在干预开始前6个月和干预开始后6个月从所有研究中心收集数据。参与者是英格兰和威尔士的22家专科药物诊所和6所监狱。本研究的主要结果指标是HCV检测个体的百分比差异（干血斑检测引入后6个月和引入前6个月检测患者百分比之间的差异）。在试验之前，在对照和干预地点，8%的患者接受了HCV检测，其中16个地点的检测率不到5%。干预和对照部位之间的平均百分比差异为14.5%（95% CI 1.3- 28%，配对t检验，P = 0.03）; 14对中有13对有助于干预的积极作用（Wilcoxon配对符号秩检验，P = 0.002）。干预和控制站点之间的差异的大小变化很大。该研究提供了初步的支持证据，即干血斑检测可以通过增加患者接受检测的机会来增加HCV诊断检测的使用率。在更多的研究中心进行额外的试验是合理的，最好是在药物和治疗政策的背景下，为感染控制和检测提供更明确的优先级（和目标）。
The objective of this study was to assess whether introducing dried blood spot testing can increase hepatitis C virus (HCV) diagnostic testing. A cluster randomized controlled trial was conducted. Sites were matched into pairs, with one site in each pair randomly allocated to receive the intervention (training and use of dried blood spot). Data were collected from all sites for 6 months before and 6 months after the start of the intervention. The participants were 22 specialist drug clinics and six prisons in England and Wales. The main outcome measure of this study was percentage point difference in individuals tested for HCV (the difference between the percentage of patients tested 6 months after and 6 months before the introduction of dried blood spot tests). Before the trial, 8% of patients at control and intervention sites had been tested for HCV, with 16 sites testing less than 5% of their caseload. The average percentage point difference between intervention and control sites was 14.5% (95% CI 1.3-28%, paired t-test, P = 0.03); with 13 of the 14 pairs contributing to the positive effect of the intervention (Wilcoxon matched-pairs signed-rank-test, P = 0.002). The size of the difference between intervention and control sites varied considerably. The study provides preliminary supporting evidence that dried blood spot testing may increase the uptake of HCV diagnostic testing, by increasing the opportunity for patients to be offered testing. Additional trials with a larger number of sites are justified, ideally in the context of drug and treatment policies that gave clearer priority (and targets) to infection control and testing.