Barriers to Treatment of Hepatitis B in an Urban Chinatown Community
Barriers to Treatment of Hepatitis B in an Urban Chinatown Community
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DOI：
10.1097/mcg.0b013e31824e159c
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发表时间：
2012-09-01
影响因子：
2.9
通讯作者：
Cotler, Scott J.
中科院分区：
文献类型：
--
作者：
Malespin, Miguel;Wong, Shirley;Cotler, Scott J.
目标：评估中国移民人群中一致努力治疗B型肝炎病毒（HBV）的净效应，包括启动和继续治疗的障碍和抗病毒efficacy.Background：口服抗病毒药物治疗HBV的病毒抑制率很高。然而，有有限的信息的影响，试图治疗HBV在高患病率的移民community.Methods：69例患者被确定在一个城市唐人街内科的做法谁有治疗HBV的indications。作出了协调一致的努力，为这些患者提供抗病毒治疗。根据对医疗记录的系统回顾，对开始治疗的障碍和停止治疗的原因进行分类。HBV DNA抑制到检测不到的水平被认为是治疗respons.Results：26%（18/69）的患者没有开始用药，因为未能随访或拒绝治疗。74%（51/69）的病例开始口服抗病毒治疗，39例继续治疗的患者中有38例达到病毒抑制。12例患者因社会、经济或其他原因而停药。总的来说，55%（38/69）的治疗候选人达到不可检测的HBV DNA水平的therapy.Conclusions：虽然口服抗病毒治疗是非常有效的，在实现病毒抑制的患者谁是维持治疗，只有55%的治疗候选人达到这一终点。护理障碍使近一半的患者无法开始或继续治疗。一个多学科的方法，包括教育和社会和财政支持是必要的，以最大限度地提高乙肝病毒治疗的好处，在这个城市移民人口。
Goals: To evaluate the net effect of a concerted effort to treat hepatitis B virus (HBV) in a Chinese immigrant population, including barriers to initiating and continuing therapy and antiviral efficacy.Background: Oral antiviral agents for HBV achieve high rates of viral suppression. However, there is limited information about the impact of attempts to treat HBV in high prevalence immigrant communities.Methods: Sixty-nine patients were identified in an urban Chinatown Internal Medicine practice who had indic ations for treatment of HBV. A coordinated effort was made to provide antiviral therapy to these patients. Barriers to starting treatment and reasons for discontinuation were categorized on the basis of a systematic review of medical records. Suppression of HBV DNA to undetectable levels was considered a treatment response.Results: Twenty-six percent (18/69) of patients did not start medication because of failure to follow-up or treatment refusal. Oral antiviral therapy was initiated in 74% (51/69) of cases and 38 of 39 patients who remained on treatment achieved viral suppression. Twelve patients discontinued medication because of social, economic, or other reasons. In total, 55% (38/69) of treatment candidates achieved undetectable HBV DNA levels on therapy.Conclusions: Although oral antiviral therapy was highly effective in achieving viral suppression in patients who were maintained on treatment, only 55% of treatment candidates reached this endpoint. Barriers to care kept nearly one half of patients from initiating or continuing therapy. A multidisciplinary approach including education and social and financial support is needed to maximize the benefit of available HBV treatment in this urban immigrant population.