Factors associated with successful referral for clinical care of drug users with chronic hepatitis C who have or are at risk for HIV infection
Factors associated with successful referral for clinical care of drug users with chronic hepatitis C who have or are at risk for HIV infection
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DOI：
10.1097/01.qai.0000131932.21612.49
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发表时间：
2004-11-01
影响因子：
3.6
通讯作者：
Klein, RS
中科院分区：
文献类型：
--
作者：
Fishbein, DA;Lo, YT;Klein, RS
本研究的目的是确定转介吸毒者（DU）与慢性丙型肝炎的临床评估和护理的结果。228名可检测到丙型肝炎病毒RNA的患者接受了快速转诊，以进行丙型肝炎的评估和可能的治疗，这些患者来自当前和既往阿片类药物成瘾DU的前瞻性研究队列。四个结果进行了分析：接受转诊，到达临床评估，肝活检，并接受治疗。127名参与者（56%）接受转诊，其中54名（43%）接受评价。在这些参与者中，12例（22%）进行了肝活检，4例（7%）接受了治疗。多变量logistic回归分析显示，HIV感染的DU接受转诊的可能性显著降低（调整后的比值比[ORadj]，0.51; 95%置信区间[CI]，0.30-0.88），老年参与者更有可能保持预约（ORadj，1.06/y; 95% CI，1.00-1.12）。在艾滋病毒血清反应阳性的参与者中，有注射史的参与者更有可能接受转诊（ORadj，3.60; 95% CI，1.08-11.96），以及HIV载量较高的人群（ORadj，0.50/log（10）; 95% CI，0.26-0.94）和西班牙裔（ORadj，0.26; 95% CI，0.07-0.89）不太可能遵守约定。尽管加快了丙型肝炎护理的转诊，但只有少数参与者接受了评估，接受治疗的人数更少。由于越来越有效的治疗，迫切需要更好的方法来改善HCV感染DU的评估和治疗，包括那些合并感染HIV的DU。
The objective of this study was to determine outcomes of referring drug users (DUs) with chronic hepatitis C for clinical evaluation and care. Two hundred twenty-eight persons with detectable hepatitis C virus RNA were given expedited referrals for evaluation and possible treatment of hepatitis C from a prospective study cohort of current and former opiate-addicted DUs. Four outcomes were analyzed: accepted referral, arrived for clinical evaluation, had liver biopsy, and received treatment. One hundred twenty-seven participants (56%) accepted referral, of whom 54 (43%) arrived for evaluation. Of these participants, 12 (22%) had liver biopsy, and 4 (7%) were treated. Multivariate logistic regression revealed that HIV-infected DUs were significantly less likely to accept referral (adjusted odds ratio [ORadj], 0.51; 95% confidence interval [CI], 0.30-0.88), and older participants were more likely to keep an appointment (ORadj, 1.06/y; 95% CI, 1.00-1.12). Of HIV-seropositive participants, those with a history of injection were more likely to accept referral (ORadj, 3.60; 95% CI, 1.08-11.96), and those with higher HIV load (ORadj, 0.50/log(10); 95% CI, 0.26-0.94) and Hispanic ethnicity (ORadj, 0.26; 95% CI, 0.07-0.89) were less likely to keep an appointment. Despite expedited referrals for hepatitis C care, only a few participants received an evaluation, and even far fewer were treated. Because increasingly effective treatment is available, better methods are urgently needed to improve evaluation and treatment of HCV-infected DUs, including those coinfected with HIV.