Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Int J Drug Policy. 2017 Sep;47:144-152. doi: 10.1016/j.drugpo.2017.05.041. Epub 2017 Jun 23.
Approximately 40%-90% of people who inject drugs (PWID) in Malaysia have hepatitis C (HCV). PWID continue to be disproportionately affected by HCV due to their lack of knowledge, perceived risk and interest in HCV treatment. Education interventions may be an effective strategy for increasing HCV knowledge in PWID, and harm reduction services are uniquely positioned to implement and deploy such interventions.
We recruited 176 clients from methadone maintenance treatment (MMT: N=110) and needle/syringe programs (NSP: N=66) between November 2015 and August 2016. After baseline knowledge assessments, clients participated in a standardized, 45-min HCV education program and completed post-intervention knowledge assessments to measure change in knowledge and treatment interest.
Participants were mostly male (96.3%), Malay (94.9%), and in their early 40s (mean=42.6years). Following the intervention, overall knowledge scores and treatment interest in MMT clients increased by 68% and 16%, respectively (p<0.001). In contrast, NSP clients showed no significant improvement in overall knowledge or treatment interest, and perceived greater treatment barriers. Multivariate linear regression to assess correlates of HCV knowledge post-intervention revealed that optimal dosage of MMT and having had an HIV test in the past year significantly increased HCV knowledge. Having received a hepatitis B vaccine, however, was not associated with increased HCV knowledge after participating in an education session.
Generally, HCV knowledge and screening is low among clients engaged in MMT and NSP services in Malaysia. Integrating a brief, but comprehensive HCV education session within harm reduction services may be a low-cost and effective strategy in improving overall HCV knowledge and risk behaviors in resource-limited settings. In order to be an effective public health approach, however, education interventions must be paired with strategies that improve social, economic and political outcomes for PWID. Doing so may reduce HCV disparities by increasing screening and treatment interest.
在马来西亚，约有 40%-90%的注射毒品者（PWID）患有丙型肝炎（HCV）。由于缺乏知识、对 HCV 治疗的认知风险和兴趣，PWID 继续受到 HCV 的不成比例影响。教育干预措施可能是提高 PWID 对 HCV 认识的有效策略，而减少伤害服务具有独特的实施和部署此类干预措施的地位。
我们于 2015 年 11 月至 2016 年 8 月期间招募了 176 名美沙酮维持治疗（MMT：N=110）和针/注射器方案（NSP：N=66）的客户。在基线知识评估后，客户参加了标准化的 45 分钟 HCV 教育计划，并完成了干预后知识评估，以衡量知识和治疗兴趣的变化。
参与者主要为男性（96.3%），马来人（94.9%），年龄在 40 岁出头（平均年龄为 42.6 岁）。干预后，MMT 客户的总体知识得分和对 MMT 的治疗兴趣分别增加了 68%和 16%（p<0.001）。相比之下，NSP 客户的总体知识或治疗兴趣没有明显提高，并且认为治疗障碍更大。评估干预后 HCV 知识相关性的多元线性回归显示，MMT 的最佳剂量和过去一年接受过 HIV 检测显著增加了 HCV 知识。然而，接种乙肝疫苗后，参加教育课程并不会增加 HCV 知识。
总体而言，在马来西亚参与 MMT 和 NSP 服务的客户中，HCV 知识和筛查率较低。在减少伤害服务中纳入简短但全面的 HCV 教育课程可能是一种在资源有限的环境中提高总体 HCV 知识和风险行为的低成本且有效的策略。然而，为了成为有效的公共卫生方法，教育干预措施必须与改善 PWID 的社会、经济和政治成果的策略相结合。这样做可以通过增加筛查和治疗兴趣来减少 HCV 差异。
