Mravčík V, Strada L, Reimer J, Schulte B
Epidemiol Mikrobiol Imunol. 2014 Nov;63(4):265-9.
Injecting drug users (IDUs) represent a major subpopulation of hepatitis C virus (HCV)-infected people in developed countries. Yet their uptake to treatment is generally low despite well-documented effectiveness of HCV treatment among former and active IDUs. The present study represents the first attempt to describe the HCV treatment coverage among IDUs and identify factors that affect treatment uptake in the Czech Republic.
From January to March 2011, a questionnaire survey was conducted among viral hepatitis treatment centres in the Czech Republic.
From a total of 76 identified hepatitis treatment centres existing in the country, 39 provided HCV treatment to (mainly former or abstaining) IDUs in 2010. Most clinicians reported being cautious in initiating HCV treatment in IDUs. Abstinence, a screening phase before treatment initiation, opioid substitution treatment and an external evaluation by a specialist were often prerequisites for skrting treatment. However, HCV treatment centres rarely provided drug-use specific services. Financial constraints were also reported, further limiting the inclusion of IDUs into treatment, as non-users are widely preferred to active drug users. Clinicians reported no difference in treatment uptake and adherence between drug users and non-users, nor between opioid and methamphetamine users.
A number of system- and provider-related factors limit HCV treatment in IDUs in the Czech Republic, despite permissive national clinical guidelines. Targeting these factors is crucial to reduce HCV prevalence at population level.
在发达国家，注射吸毒者（IDU）是丙型肝炎病毒（HCV）感染人群的主要亚群体。尽管有充分证据表明HCV治疗对既往和现有的注射吸毒者有效，但他们接受治疗的比例总体较低。本研究首次尝试描述捷克共和国注射吸毒者的HCV治疗覆盖率，并确定影响治疗接受率的因素。
2011年1月至3月，对捷克共和国的病毒性肝炎治疗中心进行了问卷调查。
在该国确定的76家肝炎治疗中心中，2010年有39家为（主要是既往或已戒毒的）注射吸毒者提供HCV治疗。大多数临床医生报告称，在开始对注射吸毒者进行HCV治疗时持谨慎态度。戒毒、治疗开始前的筛查阶段、阿片类药物替代治疗以及专家的外部评估通常是开始治疗的先决条件。然而，HCV治疗中心很少提供针对药物使用的特定服务。还报告了经济限制，这进一步限制了注射吸毒者接受治疗，因为非吸毒者比现吸毒者更受青睐。临床医生报告称，吸毒者与非吸毒者之间，以及阿片类药物使用者与甲基苯丙胺使用者之间在治疗接受率和依从性方面没有差异。
尽管国家临床指南较为宽松，但一些与系统和提供者相关的因素限制了捷克共和国注射吸毒者的HCV治疗。针对这些因素对于在人群层面降低HCV流行率至关重要。
