Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England
Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England
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DOI：
10.1016/j.drugpo.2019.102608
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发表时间：
2020-01-01
影响因子：
4.4
通讯作者：
Brown, Ashley S.
中科院分区：
文献类型：
--
作者：
Mohamed, Zameer;Al-Kurdi, Deyaa;Brown, Ashley S.
背景资料：在英格兰，为了扩大获得护理的机会，采用了自愿退出干血斑监狱艾滋病毒、B型肝炎和丙型肝炎筛查的办法。最新的进展，在床旁的丙型肝炎病毒诊断提供了一个机会，以提高诊断和治疗的吸收。我们在西伦敦的一个大型还押监狱比较了HCV护理连续体的各个方面之间的保留沿着和时间间隔，以替代快速护理点检测和简化的治疗策略，以及现有的国家选择退出HCV干血斑检测和治疗。在2017年9月至2018年12月期间，普遍选择退出干血斑点HCV检测，女王陛下监狱Wormwood Scrubs记录了临床评估和治疗接受情况。结果与基于床旁的（唾液Oraquick（R）抗HCV筛查和Xpert（R）HCV手指针刺病毒载量）筛查和简化治疗途径，为所有新到HMP Wormwood Scrubs物质滥用部门的人提供，该部门在2018年9月至12月期间与干血点检测平行运行。在研究期间，5239名囚犯中有2442人（46.6%）接受了干血点筛查，结果有62例（2.6%）HCV RNA阳性病例。13例（21.3%）患者开始治疗，迄今未观察到病毒复发病例。相比之下，162 181（89.5%）的囚犯承认的物质滥用单位同意快速点的护理检测; 20（12.3%）HCV RNA阳性病例。17名（85.0%）符合条件的囚犯开始接受治疗。中位住院时间（90与30天），筛选时间（6与2天），评估（14与3天）和治疗（36与1天）较短的快速点的护理屏幕和治疗group.Conclusion：目前的规模扩大监狱干血斑丙型肝炎病毒的筛查和治疗在英格兰是次优的。在我们的环境中，护理的级联是时间和资源敏感的，并通过引入简化的筛选和治疗策略大大改善。
Background: In England, opt-out dry blood spot prison screening for HIV, hepatitis B and hepatitis C (HCV) has been introduced to scale-up access to care. Recent advances in point-of-care HCV diagnostics provide an opportunity to improve diagnosis and treatment uptake. We compared the retention along and time intervals between each aspect of the HCV care continuum for an alternative rapid point-of-care-testing and simplified treatment strategy with existing national opt-out HCV dry blood spot testing and treatment at a large remand prison in West London.Methods: Between September 2017 and December 2018 universal opt-out dry blood spot HCV testing, clinical assessment and treatment uptake were recorded at Her Majesty's Prison Wormwood Scrubs. Outcomes were compared to a point-of-care-based (salivary Oraquick (R) anti-HCV screening and Xpert (R) HCV fingerstick viral load) screening and streamlined treatment pathway offered to all new arrivals to the HMP Wormwood Scrubs substance misuse unit, which ran in parallel to dry blood spot testing between September and December 2018.Results: During the study period 2442 out of 5239 inmates (46.6%) underwent dry blood spot screening, resulting in 62 (2.6%) HCV RNA positive cases. Thirteen (21.3%) individuals commenced therapy and no viral relapse cases were observed to date. In comparison, 162 out of 181 (89.5%) inmates admitted to the substance misuse unit agreed to rapid point-of-care testing; 20 (12.3%) HCV RNA positive cases. Seventeen (85.0%) of eligible inmates commenced treatment. The median length of stay (90 vs 30 days), time to screening (6 vs 2 days), assessment (14 vs 3 days) and treatment (36 vs 1 day) were shorter for the rapid point-of-care screen-and-treat group.Conclusion: Current scaling-up of prison dry blood spot HCV screening and treatment in England is sub-optimal. In our setting, the cascade of care is time and resource sensitive and is greatly improved by the introduction of a simplified screen-and-treat strategy.