Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia; Kirby Institute, UNSW Sydney, Sydney, Australia.
Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.
Int J Drug Policy. 2017 Sep;47:209-215. doi: 10.1016/j.drugpo.2017.05.032. Epub 2017 Jun 4.
The Kirketon Road Centre (KRC) is a community-based public health facility in Sydney, Australia, that provides healthcare to people who inject drugs (PWID), including hepatitis C virus (HCV) treatment. From March 2016, the Australian Government has provided access to direct-acting antivirals (DAA) for adults with chronic HCV, without liver disease stage or drug and alcohol use restrictions. The aim of this study was to report DAA treatment outcomes among highly marginalised PWID treated at KRC.
All individuals initiating DAA treatment at KRC and due for sustained virological response (SVR12) testing by end 2016 were included. Demographic, drug use behaviour, clinical parameters, adherence support and HCV treatment outcomes, including SVR12 were recorded. Factors associated with SVR12, loss-to-follow-up (LTFU) and delayed SVR12 testing (>SVR16) were assessed by multivariate analysis. SVR12 was assessed by intention-to-treat (ITT) and modified ITT, the latter excluding individuals with an end-of-treatment response (ETR) but no SVR12 assessment, or who postponed their SVR12 date due to treatment interruption.
A total of 72 individuals commencing DAAs were included, of whom 67% were male, 30% homeless, and 32% Aboriginal. All had a lifetime history of injecting drug use, with 75% having injected within the last six months, and 44% injecting at least weekly; 25% were also enrolled in opioid substitution therapy. Twenty-five (35%) individuals elected to receive an enhanced adherence-support package. Fifty-nine of 72 (82%) individuals due for SVR12 attended for testing, of whom 59/59 (100%) achieved SVR, providing an ITT SVR of 82%. A further six individuals had undetectable HCV RNA at ETR, but no SVR12 assessment, and one interrupted treatment, providing a mITT SVR of 91%. Homelessness was associated with delayed SVR12 testing (OR 24.9 95%CI 2.9-212.8, p=0.003). There was no association between LTFU and frequency of drug injection, last drug injected, or planned treatment duration.
This study confirms that PWID can be successfully treated for HCV in a real-world setting using an integrated primary health care model. It also demonstrates feasibility to upscale DAA therapy in high-risk PWID populations, with potential individual and population-level public health benefits. Enhanced efforts are required to optimise post-treatment follow-up.
Kirketon 路中心（KRC）是澳大利亚悉尼的一个社区基础公共卫生机构，为注射毒品者（PWID）提供医疗服务，包括丙型肝炎病毒（HCV）治疗。自 2016 年 3 月起，澳大利亚政府为慢性 HCV 成人提供直接作用抗病毒药物（DAA），没有肝脏疾病阶段或药物和酒精使用限制。本研究的目的是报告在 KRC 接受治疗的高度边缘化的 PWID 的 DAA 治疗结果。
所有在 KRC 开始 DAA 治疗且在 2016 年底前需要进行持续病毒学应答（SVR12）检测的个体均被纳入。记录人口统计学、药物使用行为、临床参数、依从性支持和 HCV 治疗结果，包括 SVR12。通过多变量分析评估 SVR12、失访（LTFU）和延迟 SVR12 检测（>SVR16）的相关因素。通过意向治疗（ITT）和修改后的 ITT 评估 SVR12，后者排除了 ETR 但没有 SVR12 评估的个体，或因治疗中断而推迟 SVR12 日期的个体。
共纳入 72 名开始接受 DAA 治疗的个体，其中 67%为男性，30%无家可归，32%为土著。所有人都有终生吸毒史，75%在过去 6 个月内注射过毒品，44%每周至少注射一次；25%还参加了阿片类药物替代治疗。25（35%）名个体选择接受强化依从性支持包。72 名应进行 SVR12 检测的个体中有 59 名（82%）接受了检测，其中 59/59（100%）实现了 SVR，提供了 82%的 ITT SVR。另有 6 名个体在 ETR 时 HCV RNA 检测不到，但没有 SVR12 评估，1 名个体中断了治疗，提供了 mITT SVR 为 91%。无家可归与延迟 SVR12 检测有关（OR 24.995%CI 2.9-212.8，p=0.003）。LTFU 与药物注射频率、最后一次注射药物或计划治疗持续时间之间没有关联。
本研究证实，在真实环境中，通过综合初级保健模式，PWID 可以成功治疗 HCV。它还表明，在高危 PWID 人群中扩大 DAA 治疗的可行性，具有潜在的个体和人群公共卫生效益。需要加强努力，优化治疗后的随访。
