上海市社区戒毒人员中丙型肝炎病毒感染者的治疗意愿和支付能力分析  

Treatment willingness and capacity to pay for hepatitis C virus infection among the community detoxification population in Shanghai

作　　者：梁鹏飞 季桂春 陈昕 屈凌霄 沈鑫[1] 陈恺韵 徐迪 施阳[1] 任宏[1] 李健[3] LIANG Pengfei;JI Guichun;CHEN Xin;QU Lingxiao;SHEN Xin;CHEN Kaiyun;XU Di;SHI Yang;REN Hong;LI Jian(Shanghai Center for Disease Control and Prevention,Shanghai 200336,China;Shanghai Beicai Community Health Service Center,Shanghai 201204,China;National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]上海市疾病预防控制中心,上海200336 [2]上海市北蔡社区卫生服务中心,上海201204 [3]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206

出　　处：《中国艾滋病性病》2025年第1期45-49,共5页Chinese Journal of Aids & STD

基　　金：上海市加强公共卫生体系建设三年行动计划(GWVI-9);上海市卫生健康委青年课题(20224Y0333)。

摘　　要：目的了解上海市社区戒毒人员中丙型肝炎(简称丙肝)病毒感染者的治疗意愿和支付能力,评估预期治疗情况,为优化戒毒人群丙肝防控策略提供科学依据。方法对2022年上海市徐汇区、静安区和宝山区在管社区戒毒人员中HCV抗体阳性者开展问卷调查,收集其一般人口社会学信息、既往吸食毒品情况、家庭收入、医疗保险、丙肝治疗意愿和个人自费就医支付能力等信息,采血开展HCV核酸检测,结合个人自费就医支付能力及医疗保险类型评估丙肝治疗支付能力,计算预期治疗率。结果本次参加调查的社区戒毒HCV感染者492人,核酸阳性率为62.6%(308人),具备治疗意愿者占比为67.9%(334人),44岁及以下年龄组(相较45~59岁年龄组,aOR=2.149,95%CI:1.105~4.181)、个人缴纳医疗保险(aOR=2.355,95%CI:1.267~4.376)、个人自费就医支付能力强(aOR=2.998,95%CI:2.218~4.052)是丙肝治疗意愿的促进因素,女性(aOR=1.758,95%CI:1.164~2.655)、高学历(aOR=1.525,95%CI:1.005~2.313)是HCV感染者“既往自愈或治愈”的促成因素。基于上海市现行医疗保险政策,预期治疗率最高可达55.2%,如考虑为有注射吸毒史者提供治疗减免,则可继续提高至75.3%。结论上海市社区戒毒人群丙肝治疗意愿较高,但实际治愈情况不甚理想,即便充分利用各项医疗保险政策利好,预期治疗率也难以满足丙肝消除目标,建议进一步探索社区诊疗点等丙肝下沉式诊疗管理服务和“个人-医疗保险-财政-慈善救助”的分担减免支付模式。Objective To investigate the treatment willingness and capacity to pay of hepatitis C virus(HCV)infected individuals among the community detoxification population in Shanghai,evaluate the expected treatment situation,and provide a scientific basis for optimizing prevention and control strategies for hepatitis C infection among this population.Methods In 2022,a questionnaire survey was conducted among HCV antibody positive individuals within the community detoxification population in Xuhui,Jing'an,and Baoshan Districts of Shanghai.This survey collected demographic and sociological data,past drug use history,family income,medical insurance status,willingness to undergo HCV treatment,personal payment capability for medical services,and blood samples for HCV nucleic acid testing.Capacity of pay for HCV treatment was evaluated in conjunction with the type of medical insurance used to calculate the expected treatment rate.Results Among the 492 community-dwelling individuals with HCV infection who participated in the survey,the positivity rate of HCV nucleic acid was 62.6%(308 individuals),and 67.9%(334 individuals)expressed a willingness to receive treatment.Factors that facilitated treatment willingness included being aged≤44 years(compared to the age group 45-59,a OR=2.149,95%CI:1.105-4.181),having personal health insurance(a OR=2.355,95%CI:1.267-4.376),and possessing a strong personal payment ability for medical services(a OR=2.998,95%CI:2.218-4.052).Being female(a OR=1.758,95%CI:1.164-2.655)and having a higher education level(a OR=1.525,95%CI:1.005-2.313)were contributing factors to a history of"self-resolved or cured"HCV infection.Based on the current medical insurance policies in Shanghai,the highest potential treatment rate could reach 55.2%,and considering treatment discounts for individuals with a history of injection drug use,this could further increase to 75.3%.Conclusions The drug detoxification community in Shanghai exhibits a high willingness for HCV treatment;however,the actual cure rates are suboptima

关 键 词：丙型肝炎 社区戒毒 治疗 医疗保险 

分 类 号：R512.6[医药卫生—内科学]