緊急診療室におけるC型肝炎スクリーニング:DETECTC型肝炎ランダム化臨床試験
Jason Haukoos1,2,3,4, Richard E Rothman5, James W Galbraith6
1Department of Emergency Medicine, Denver Health, Denver, Colorado.
JAMA
|July 9, 2025
まとめ
緊急治療室での非標的型C型肝炎ウイルス (HCV) のスクリーニングでは,標的型スクリーニングよりも多くの新規感染が確認されました. しかし,介護と治療の完了との関連性は,両方のアプローチにとって重要な課題です.
科学分野:
- 公衆衛生
- 感染症
- ヘパトロジー
背景:
- C型肝炎ウイルス (HCV) 感染の特定は公衆衛生上の優先事項です.
- 緊急治療室 (ED) は,一貫した医療へのアクセスを欠くリスクのある集団をスクリーニングするための重要な場所です.
- EDにおける最適なHCVスクリーニング戦略はまだ確立されていません.
研究 の 目的:
- 緊急治療室での非標的対標的のHCVスクリーニングの有効性を比較する.
- 標的型スクリーニングよりも非標的型スクリーニングで新しいHCV診断が多くなるという仮説を検証する.
主な方法:
- 3つの都市部のEDで147,498人の患者さんを対象とした 多中心の実践的ランダム化臨床試験です
- 18歳以上の患者は,非標的 (普遍的) または標的 (リスクに基づく) HCVスクリーニングにランダムに割り当てられました.
- 主なアウトカムには,新たに診断されたHCV感染 (RNA検出) であり,次要アウトカムには,ケアと治療のマイルストーンとの関連が含まれていた.
主要な成果:
- 標的型スクリーニングでは,標的型スクリーニング (115) と比較して,新規HCV感染が有意に多く確認された (RR,1.34;P=.02).
- HCV検査率は,非標的検査では13. 4%,標的検査では6. 3%でした.
- 治療開始,治療終了,および持続したウイルス反応 (SVR12) の割合は,両方のグループで低かった.
結論:
- 非標的型HCVスクリーニングは,都市部のED環境での症例検出の優れた戦略です.
- 診断から持続的なウイルス反応まで,HCVの治療継続において,重要なギャップが存在します.
- HCV治療の取り組みと成果を向上させるために 革新的なモデルが緊急に必要とされています
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