Point-of-care hepatitis C screening with direct access referral to improve linkage to care among halfway house residents: a pilot randomised study.

Autor:	Hsiang JC; Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.; Department of Gastroenterology, Sengkang General Hospital, Singapore.; Yong Loo Lin School of Medicine, Singapore., Sinnaswami P; Saw Swee Hock School of Public Health, National University of Singapore, Singapore., Lee MY; Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore., Zhang MM; Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore., Quek KE; Clinical Trials and Research Unit, Changi General Hospital, Singapore., Tan KH; Clinical Trials and Research Unit, Changi General Hospital, Singapore., Wong YM; Clinical Trials and Research Unit, Changi General Hospital, Singapore., Thurairajah PH; Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.; Yong Loo Lin School of Medicine, Singapore.; National University Hospital, Singapore.
Jazyk:	angličtina
Zdroj:	Singapore medical journal [Singapore Med J] 2022 Feb; Vol. 63 (2), pp. 86-92. Date of Electronic Publication: 2020 Jul 30.
DOI:	10.11622/smedj.2020116
Abstrakt:	Introduction: Linkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group. Methods: All participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment. Results: 351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis. Conclusion: PoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population. (Copyright: © Singapore Medical Association.)
Databáze:	MEDLINE
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