Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada; University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada.
Vancouver Coastal Health Authority, Pender Community Health Centre, 59 West Pender St, Vancouver, BC V6B 1R3, Canada.
Int J Drug Policy. 2018 Sep;59:76-84. doi: 10.1016/j.drugpo.2018.06.019. Epub 2018 Jul 24.
Treatment of hepatitis c virus (HCV) with direct-acting-antivirals (DAAs) by family physicians in primary care and addiction settings may allow treatment expansion to inner-city populations, including people who inject drugs (PWID). Real-world data however, suggests high rates of non-attendance to SVR 12 testing. This study examines outcomes of HCV treatment delivered by family physicians working in interdisciplinary treatment programs, integrated into inner-city primary care clinics.
In this prospective cohort, participants completed baseline questionnaires, including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR 12) if HCV RNA was undetectable 12 weeks following end of therapy, and were recorded as lost to follow-up (LTFU) if they did not present for an HCV follow-up visit. SVR was calculated in intention to treat (ITT) as well as modified intention to treat (mITT) analysis, which excluded those who completed treatment but had no SVR 12 result. A logistic regression model assessed factors associated with LTFU.
Of 138 individuals included in the analysis, 52% were on opioid agonist therapy (OAT), 75% reported a history of injection drug use (IDU), with 25% reporting IDU in the month prior to treatment initiation. ITT SVR across all sites and genotypes was 86% and mITT was 95%. There was a significant difference in mITT for those reporting recent IDU compared to those who did not (87% vs 99% p = 0.03). While 13% were LTFU at SVR 12, participants receiving OAT in the same clinic as HCV treatment were less likely to be LTFU (aOR 0.09(0.02-0.46)).
HCV treatment by family physicians, along with interdisciplinary teams, can be successful in inner-city populations in the era of DAAs; however, follow-up after treatment is a challenge. Integrating OAT in the same location as HCV treatment may help to improve follow-up.
家庭医生在初级保健和成瘾治疗环境中使用直接作用抗病毒药物（DAAs）治疗丙型肝炎病毒（HCV），可能会将治疗范围扩大到包括注射毒品者（PWID）在内的城市内人群。然而，实际数据表明，未能按时进行 SVR12 检测的比例较高。本研究考察了在城市内初级保健诊所中，从事跨学科治疗项目的家庭医生提供 HCV 治疗的结果。
在这项前瞻性队列研究中，参与者完成了基线问卷，包括人口统计学和药物使用方面的问题。如果 HCV RNA 在治疗结束后 12 周内无法检测到，则将参与者记录为获得持续病毒学应答（SVR12），如果他们未进行 HCV 随访就诊，则将其记录为失访（LTFU）。按照意向治疗（ITT）和改良意向治疗（mITT）分析计算 SVR，后者排除了那些完成治疗但没有 SVR12 结果的患者。使用逻辑回归模型评估与 LTFU 相关的因素。
在纳入分析的 138 名患者中，52%正在接受阿片类药物激动剂治疗（OAT），75%报告有注射药物使用史（IDU），其中 25%在开始治疗前的一个月内有 IDU。所有地点和基因型的 ITT SVR 为 86%，mITT 为 95%。与未报告近期 IDU 的患者相比，报告近期 IDU 的患者的 mITT 有显著差异（87%比 99%，p=0.03）。尽管在 SVR12 时有 13%的患者失访，但在接受 HCV 治疗的同时在同一诊所接受 OAT 的患者，LTFU 的可能性较低（优势比 0.09（0.02-0.46））。
在直接作用抗病毒药物时代，家庭医生与跨学科团队合作，可以在城市内人群中成功治疗 HCV；然而，治疗后的随访是一个挑战。在 HCV 治疗的同一地点整合 OAT 可能有助于改善随访。
