Linkage to hepatitis C care after incarceration in jail: a prospective, single arm clinical trial
Linkage to hepatitis C care after incarceration in jail: a prospective, single arm clinical trial
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DOI：
10.1186/s12879-019-4344-1
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发表时间：
2019-08-08
影响因子：
3.7
通讯作者：
Carmody, Ellie
中科院分区：
文献类型：
--
作者：
Akiyama, Matthew J.;Columbus, Devin;Carmody, Ellie
背景丙型肝炎病毒（HCV）是一个主要的公共卫生问题，在惩教机构。由于停留时间短，HCV治疗在美国监狱中通常不可能。在这些环境中，与护理的联系至关重要，但相互竞争的优先事项使社区医疗保健的参与和监禁后的保留复杂化。方法：我们进行了一项单臂临床试验，结合过渡性护理协调（TCC）和患者导航干预，并评估了监禁后与HCV护理相关的联系率和相关因素。结果在干预期间，84名参与者在指数监禁后返回社区。大多数参与者是男性和西班牙裔，有精神疾病史，平均年龄为45岁。在返回社区的人中，26人（31%）在中位20.5天内接受了HCV治疗; 17人（20%）开始了HCV治疗，15人（18%）完成了治疗，9人（11%）进行了后续实验室检查以确认持续病毒学反应（SVR），7人（8%）有记录的SVR。在有随访实验室的患者中，已知SVR率为（7/9）78%。表达偏好与参与者现有的卫生系统相关联，在监禁前服用美沙酮，以及感觉家人或亲人关心参与者的健康与HCV护理相关。报告饮酒中毒监禁前与丙型肝炎护理的联系呈负相关。结论：我们证明，TCC和患者导航相结合的综合策略可能有效地实现及时与HCV护理的联系。旨在治疗药物使用障碍和增加社会支持的其他多成分干预措施可能会导致进一步改善。
Background Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement.