Impact of routine opt-out HIV/HCV screening on testing uptake at a syringe services program: An interrupted time series analysis.
Impact of routine opt-out HIV/HCV screening on testing uptake at a syringe services program: An interrupted time series analysis.
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DOI：
10.1016/j.drugpo.2020.102875
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Feaster DJ
中科院分区：
文献类型：
--
作者：
Bartholomew TS;Tookes HE;Serota DP;Behrends CN;Forrest DW;Feaster DJ
丙型肝炎（HCV）是注射毒品（PWID）人群中最常见的传染病。让PWID参与减少伤害服务，如注射器服务计划（SSP），对于减少HCV和HIV传播至关重要。此外，PWID中的HIV和HCV检测对于改善诊断和与护理的联系非常重要。2018年3月1日，佛罗里达唯一法律的SSP在注册时实施了捆绑式选择退出HIV/HCV检测。我们的目的是研究艾滋病毒/丙型肝炎病毒检测吸收的差异之前和之后的选择退出检测政策的实施。多变量logistic回归分析用于评估接受HIV/HCV检测的预测因素，控制选择加入和选择退出政策。每月估计接受HIV检测，HCV检测或两者兼而有之的参与者的百分比。中断时间序列（ITS）分析评估了直接政策对艾滋病毒/丙型肝炎病毒捆绑检测的吸收水平和吸收趋势的影响，在选择退出检测政策前后。总研究期为2016年12月至2020年1月的37个月，其中512名SSP参与者在实施捆绑式HIV/HCV选择退出检测后15个月和547名SSP参与者在实施捆绑式HIV/HCV选择退出检测后22个月。接受两种HIV/HCV检测的显著预测因素为可卡因注射（aOR = 2.36）、自报HIV阳性状态（aOR = 0.39）和自报HCV阳性状态（aOR = 0.27）。根据ITS结果，在政策变更为选择退出检测后，立即进行HIV/HCV检测的人数显著增加了42.4%（95% CI：26.2%-58.5%，p < 0.001）。捆绑式选择退出HIV/HCV检测大大增加了SSP客户在加入该计划时接受HIV和HCV快速检测的百分比，并且在选择退出检测政策后的22个月内效果保持稳定。未来的调查必须评估PWID水平的测试偏好的角度来看，并检查这种测试方法是否提高了艾滋病毒/丙型肝炎病毒检测PWID以前不知道他们的状态。
Hepatitis C (HCV) is the most common infectious disease among people who inject drugs (PWID). Engaging PWID in harm reduction services, such as syringe service programs (SSPs), is critical to reduce HCV and HIV transmission. Additionally, testing for HIV and HCV among PWID is important to improve diagnosis and linkage to care. On March 1, 2018, Florida’s only legal SSP implemented bundled opt-out HIV/HCV testing at enrollment. We aimed to examine the differences in HIV/HCV testing uptake before and after the implementation of the opt-out testing policy. Multivariable logistic regression was used to assess predictors of accepting HIV/HCV tests, controlling for opt-in and opt-out policy. Monthly estimates of the percent of participants accepting an HIV test, HCV test, or both were generated. Interrupted Time Series (ITS) analysis evaluated the immediate policy impact on level of uptake and trend in uptake over time for bundled HIV/HCV testing before and after the opt-out testing policy. The total study period was 37 months between December 2016–January 2020 with 512 SSP participants 15 months prior and 547 SSP participants 22 months after implementation of bundled HIV/HCV opt-out testing. Significant predictors of accepting both HIV/HCV tests were cocaine injection (aOR = 2.36), self-reported HIV positive status (aOR = 0.39) and self-reported HCV positive status (aOR = 0.27). Based on the ITS results, there was a significant increase in uptake of HIV/HCV testing by 42.4% (95% CI: 26.2%–58.5%, p < 0.001) immediately after the policy change to opt-out testing. Bundled opt-out HIV/HCV testing substantially increased the percentage of SSP clients who received HIV and HCV rapid tests at enrollment into the program, and the effect remained stable across the 22 months post opt-out testing policy. Future investigation must assess PWID-level perspective of testing preferences and examine whether this testing approach improves HIV/HCV detection among PWID previously unaware of their status.
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