Harm Reduction Victoria, P.O. Box 12720, A'Beckett Street, Melbourne, Victoria 8006, Australia.
Centre for Social Research in Health (CSRH), University of New South Wales (NSW), Sydney, Australia.
Int J Drug Policy. 2017 Dec;50:111-115. doi: 10.1016/j.drugpo.2017.08.004. Epub 2017 Sep 18.
This commentary seeks to examine the role, value and importance of peer-based programmatic approaches for ensuring the effective roll-out of the new hepatitis C (HCV) treatments among those most affected - that is, people who inject drugs (PWID). The authors examine recent approaches to HCV treatment in Australia including the provision of universal access to the new DAA regimens regardless of acquisition, genotype or severity of disease. These approaches are contextualised within wider global strategies to support HCV elimination as a public health threat by 2030 (WHO, 2016). Despite the unprecedented opportunity presented by the availability of the new treatments, the fact remains that those most affected by hepatitis C are still largely hidden and disconnected from the health system and are likely to stay that way without targeted education and support. There is a need to for greater investment in new and innovative HCV+ PWID peer education approaches for HCV diagnosis and treatment that add value to existing models of care to improve pathways and support people across their entire treatment journey. Key components include expanding existing peer-based programmes and developing new innovative peer initiatives, supporting the development of the PWID peer workforce, developing new, targeted peer education resources and promoting linkages and partnerships between peer based and HCV treatment service providers in primary and community settings. Our approach to HCV elimination needs to take account of people's broader lives, their vulnerabilities, their life journeys and their potential points of connection, engagement and access. Peer-based organisations and networks provide that unique point of engagement and access for those HCV+ PWID for whom the health system is an unfamiliar even forbidding place or for whom hepatitis C can be but one of many overwhelming issues in the lives.
这篇评论旨在探讨基于同行的项目方法在确保新丙型肝炎(HCV)治疗方案在受影响最大的人群(即注射毒品者)中的有效实施中的作用、价值和重要性。作者审查了澳大利亚最近的 HCV 治疗方法,包括无论获得途径、基因型或疾病严重程度如何,都普遍获得新的 DAA 方案。这些方法是在更广泛的全球战略背景下提出的,旨在支持到 2030 年消除 HCV 作为公共卫生威胁(世界卫生组织,2016 年)。尽管新治疗方法的出现带来了前所未有的机会,但事实仍然是,受 HCV 影响最大的人群仍然在很大程度上被隐藏起来,与卫生系统脱节,如果没有有针对性的教育和支持,他们很可能会保持这种状态。需要加大对新的和创新的 HCV+PWID 同行教育方法的投资,以提高 HCV 诊断和治疗的价值,改进现有护理模式,为整个治疗过程中的人们提供支持。关键组成部分包括扩大现有的同行方案和开发新的创新同行举措,支持 PWID 同行工作人员的发展,开发新的、有针对性的同行教育资源,并促进初级和社区环境中基于同行和 HCV 治疗服务提供者之间的联系和伙伴关系。我们消除 HCV 的方法需要考虑到人们更广泛的生活、他们的脆弱性、他们的生活轨迹以及他们潜在的联系、参与和获得途径。同行组织和网络为那些 HCV+PWID 提供了独特的接触和获得途径,对他们来说,卫生系统是一个陌生甚至令人生畏的地方,或者对他们来说,HCV 可能只是生活中众多压倒性问题之一。
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