PDF(Pubmed)
Abstract：
BACKGROUND: Prevalence of hepatitis C virus (HCV) infection among people who inject drugs in the state of Manipur, India, is 43%; however, access to care is poor. We piloted a Community-led and comprehensive hepatitis care model that included same-day HCV treatment at drug treatment centres.
METHODS: Screening was conducted through venipuncture samples collected by community peer PWID, using HCV antibody (HCV Ab) rapid screening and hepatitis B virus (HBV) surface antigen (HBsAg) rapid diagnostic tests. Reactive HCV Ab samples were tested for HCV RNA using near point-of-care Truenat® HCV on Truelab® Quattro. Eligible HCV RNA-positive participants were treated on the same day using direct-acting antivirals and followed for sustained virologic response (SVR). HBsAg-negative participants received rapid HBV vaccination regimen while those positive for HBsAg were tested for DNA and referred for treatment.
RESULTS: Between November 2021 and August 2022, 643 individuals were approached and 503 consented and were screened. All screened were males with history of injection drug use, and a median age of 27 years (IQR 23-32). Of the 241 (47.9%) HCV Ab reactive all underwent RNA testing and 156 (64.7%) were RNA detectable. Of those with viraemia, 155 (99.4%) were initiated on treatment with 153 (98.1%) on same day, with 2 (1.2%) HBsAg positive and waiting for HBV DNA results. Among those 153, median time from HCV Ab screening to treatment was 6 h 38 min (IQR 5 h 42 min-8 h 23 min). In total 155 (100%) completed HCV treatment, of those 148 (95.5%) completed SVR testing and 130 (87.8%) achieved SVR12. 27 (5%) participants were HBsAg-positive, 3 (11.1%) were also living with HCV viraemia; 443 (97.6%) were eligible for vaccination and 436 (98.4%) received all 3 vaccine doses.
CONCLUSIONS: Community-led hepatitis care incorporating same day \"test and treat\" for HCV was feasible and effective. HBV screening identified a large proportion who were unvaccinated. Peer support extended resulted in ensuring compliance to care and treatment cascade and completing all the three doses of HBV vaccination. As the screening, diagnostics infrastructure and vaccine are available in most countries with national viral hepatitis programs also in place, our model can be adapted or replicated to progress towards global elimination targets.
METHODS: Screening was conducted through venipuncture samples collected by community peer PWID, using HCV antibody (HCV Ab) rapid screening and hepatitis B virus (HBV) surface antigen (HBsAg) rapid diagnostic tests. Reactive HCV Ab samples were tested for HCV RNA using near point-of-care Truenat® HCV on Truelab® Quattro. Eligible HCV RNA-positive participants were treated on the same day using direct-acting antivirals and followed for sustained virologic response (SVR). HBsAg-negative participants received rapid HBV vaccination regimen while those positive for HBsAg were tested for DNA and referred for treatment.
RESULTS: Between November 2021 and August 2022, 643 individuals were approached and 503 consented and were screened. All screened were males with history of injection drug use, and a median age of 27 years (IQR 23-32). Of the 241 (47.9%) HCV Ab reactive all underwent RNA testing and 156 (64.7%) were RNA detectable. Of those with viraemia, 155 (99.4%) were initiated on treatment with 153 (98.1%) on same day, with 2 (1.2%) HBsAg positive and waiting for HBV DNA results. Among those 153, median time from HCV Ab screening to treatment was 6 h 38 min (IQR 5 h 42 min-8 h 23 min). In total 155 (100%) completed HCV treatment, of those 148 (95.5%) completed SVR testing and 130 (87.8%) achieved SVR12. 27 (5%) participants were HBsAg-positive, 3 (11.1%) were also living with HCV viraemia; 443 (97.6%) were eligible for vaccination and 436 (98.4%) received all 3 vaccine doses.
CONCLUSIONS: Community-led hepatitis care incorporating same day \"test and treat\" for HCV was feasible and effective. HBV screening identified a large proportion who were unvaccinated. Peer support extended resulted in ensuring compliance to care and treatment cascade and completing all the three doses of HBV vaccination. As the screening, diagnostics infrastructure and vaccine are available in most countries with national viral hepatitis programs also in place, our model can be adapted or replicated to progress towards global elimination targets.
摘要：
背景：在曼尼普尔邦注射药物的人群中，丙型肝炎病毒（HCV）感染的患病率，印度,是43%；然而，获得护理的机会很差。我们试行了社区主导的全面肝炎护理模式，其中包括在药物治疗中心进行当日HCV治疗。
方法：通过社区同伴PWID收集的静脉穿刺样本进行筛查，使用HCV抗体（HCVAb）快速筛查和乙型肝炎病毒（HBV）表面抗原（HBsAg）快速诊断测试。使用Truelab®Quattro上的近护理点Truenat®HCV测试反应性HCVAb样品的HCVRNA。合格的HCVRNA阳性参与者在同一天使用直接作用抗病毒药物进行治疗，并随访持续病毒学应答（SVR）。HBsAg阴性的参与者接受快速HBV疫苗接种方案，而HBsAg阳性的参与者进行DNA测试并转介治疗。
结果：在2021年11月至2022年8月之间，共接触了643名个体，其中503人同意并进行了筛选。所有筛查者均为有注射用药史的男性,年龄中位数为27岁（IQR23-32）。在241（47.9％）的HCVAb反应性中，所有都进行了RNA测试，并且156（64.7％）可检测到RNA。在那些患有病毒血症的人中，155（99.4%）在同一天开始治疗153（98.1%），2（1.2％）HBsAg阳性，等待HBVDNA结果。在这153人中，从HCVAb筛查到治疗的中位时间为6h38分钟（IQR5h42分钟-8h23分钟）。在总共155（100％）完成HCV治疗，其中148人（95.5%）完成SVR测试，130人（87.8%）达到SVR12。27（5％）的参与者是HBsAg阳性，3例（11.1％）也患有HCV病毒血症；443例（97.6％）符合疫苗接种条件，436例（98.4％）接受了所有3种疫苗剂量。
结论：社区主导的肝炎护理结合当天“检测和治疗”的HCV是可行和有效的。HBV筛查确定了大部分未接种疫苗的人。同行支持扩展导致确保遵守护理和治疗级联并完成所有三个剂量的HBV疫苗接种。作为筛选，诊断基础设施和疫苗在大多数国家都有国家病毒性肝炎计划，我们的模型可以适应或复制，以实现全球消除目标。
方法：通过社区同伴PWID收集的静脉穿刺样本进行筛查，使用HCV抗体（HCVAb）快速筛查和乙型肝炎病毒（HBV）表面抗原（HBsAg）快速诊断测试。使用Truelab®Quattro上的近护理点Truenat®HCV测试反应性HCVAb样品的HCVRNA。合格的HCVRNA阳性参与者在同一天使用直接作用抗病毒药物进行治疗，并随访持续病毒学应答（SVR）。HBsAg阴性的参与者接受快速HBV疫苗接种方案，而HBsAg阳性的参与者进行DNA测试并转介治疗。
结果：在2021年11月至2022年8月之间，共接触了643名个体，其中503人同意并进行了筛选。所有筛查者均为有注射用药史的男性,年龄中位数为27岁（IQR23-32）。在241（47.9％）的HCVAb反应性中，所有都进行了RNA测试，并且156（64.7％）可检测到RNA。在那些患有病毒血症的人中，155（99.4%）在同一天开始治疗153（98.1%），2（1.2％）HBsAg阳性，等待HBVDNA结果。在这153人中，从HCVAb筛查到治疗的中位时间为6h38分钟（IQR5h42分钟-8h23分钟）。在总共155（100％）完成HCV治疗，其中148人（95.5%）完成SVR测试，130人（87.8%）达到SVR12。27（5％）的参与者是HBsAg阳性，3例（11.1％）也患有HCV病毒血症；443例（97.6％）符合疫苗接种条件，436例（98.4％）接受了所有3种疫苗剂量。
结论：社区主导的肝炎护理结合当天“检测和治疗”的HCV是可行和有效的。HBV筛查确定了大部分未接种疫苗的人。同行支持扩展导致确保遵守护理和治疗级联并完成所有三个剂量的HBV疫苗接种。作为筛选，诊断基础设施和疫苗在大多数国家都有国家病毒性肝炎计划，我们的模型可以适应或复制，以实现全球消除目标。
