Fortier Emmanuel, Alavi Maryam, Micallef Michelle, Dunlop Adrian J, Balcomb Annie C, Day Carolyn A, Treloar Carla, Bath Nicky, Haber Paul S, Dore Gregory J, Bruneau Julie, Grebely Jason
Département de médecine familiale et de médecine d'urgence, Université de Montréal, Montréal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
Int J Drug Policy. 2015 Nov;26(11):1094-102. doi: 10.1016/j.drugpo.2015.06.001. Epub 2015 Jun 11.
The objective was to assess social functioning and its association with treatment intent, specialist assessment and treatment uptake for hepatitis C virus (HCV) infection among people with a history of injecting drug use.
ETHOS is a prospective observational cohort evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from nine community health centres and opioid substitution treatment clinics (NSW, Australia). Social functioning was assessed using a short form of the Opioid Treatment Index social functioning scale. Those classified in the highest quartile (score >6) were considered having lower social functioning. Analyses were performed using logistic regression.
Among 415 participants (mean age 41 years, 71% male), 24% were considered having lower social functioning, 70% had early HCV treatment intent (intention to be treated in the next 12 months), 53% were assessed by a specialist and 27% initiated treatment. Lower social functioning was independently associated with unemployment, unstable housing, recent injecting drug use and moderate to extremely severe symptoms of depression, anxiety and stress. Lower social functioning was independently associated with reduced early HCV treatment intent (aOR 0.51, 95% CI 0.30-0.84) and lower specialist assessment (aOR 0.48, 95% CI 0.29-0.79), but not HCV treatment uptake (aOR 0.76, 95% CI 0.40-1.43). Living with someone was independently associated with HCV treatment uptake (with someone and children: aOR 2.28, 95% CI 1.01-5.14; with someone and no children: aOR 2.36, 95% CI 1.30-4.31), but not early HCV treatment intent or specialist assessment.
This study highlights the need for the development and implementation of strategies targeting people who inject drugs with lower social functioning to enhance HCV treatment intent and specialist assessment. Further, strategies to enhance social support may play a role in increasing HCV treatment uptake.
目的是评估有注射吸毒史人群的社会功能及其与丙型肝炎病毒（HCV）感染的治疗意愿、专科评估和治疗接受情况之间的关联。
ETHOS是一项前瞻性观察队列研究，评估从九个社区卫生中心和阿片类药物替代治疗诊所（澳大利亚新南威尔士州）招募的慢性HCV感染者和有注射吸毒史人群的HCV评估和治疗情况。使用阿片类药物治疗指数社会功能量表的简版评估社会功能。那些被归类在最高四分位数（得分>6）的人被认为社会功能较低。使用逻辑回归进行分析。
在415名参与者（平均年龄41岁，71%为男性）中，24%被认为社会功能较低，70%有早期HCV治疗意愿（打算在未来12个月内接受治疗），53%接受了专科评估，27%开始治疗。社会功能较低与失业、住房不稳定、近期注射吸毒以及中度至极其严重的抑郁、焦虑和压力症状独立相关。社会功能较低与早期HCV治疗意愿降低（调整后比值比0.51，95%置信区间0.30 - 0.84）和专科评估较低（调整后比值比0.48，95%置信区间0.29 - 0.79）独立相关，但与HCV治疗接受情况无关（调整后比值比0.76，95%置信区间0.40 - 1.43）。与他人同住与HCV治疗接受情况独立相关（与他人及子女同住：调整后比值比2.28，95%置信区间1.01 - 5.14；与他人同住但无子女：调整后比值比2.36，95%置信区间1.30 - 4.31），但与早期HCV治疗意愿或专科评估无关。
本研究强调需要制定和实施针对社会功能较低的注射吸毒者的策略，以提高HCV治疗意愿和专科评估。此外，增强社会支持的策略可能在增加HCV治疗接受情况方面发挥作用。
