Delile Jean-Michel, de Ledinghen Victor, Jauffret-Roustide Marie, Roux Perrine, Reiller Brigitte, Foucher Juliette, Dhumeaux Daniel
Comité d'étude et d'information sur la drogue et les addictions (CEID), 20, place Pey-Berland, 33000 Bordeaux, France.
2Hôpital du Haut-Lévêque, Pessac, France.
Hepatol Med Policy. 2018 Jun 5;3:7. doi: 10.1186/s41124-018-0033-8. eCollection 2018.
After France removed hepatitis C treatment reimbursement restrictions on 25 May 2016, an expert report presented recommendations, which focused on vulnerable groups including people who inject drugs (PWID). This commentary presents the key points of the chapter with a particular focus on policy. Thanks to the official lifting of restrictions based on disease stage and to the excellent efficacy and tolerance of the new DAA (Direct-Acting Antivirals) among PWID, the main issue is to improve the HCV care cascade. In France, many HCV-infected PWID, especially active/current PWID, remain undiagnosed and unlinked to care. Our challenge is to improve HCV screening by point of care testing (POCT), outreach methods with mobile teams, rapid tests, FibroScan, etc. and to provide PWID with appropriate services in all the settings they attend, such as drug treatment or harm reduction services, social services, prisons, etc. Another important issue is the prevention of reinfection through comprehensive and long-term follow-up. The report recommends a new national policy: testing and treating PWID as a priority, since this is the best way to eliminate HCV infection. It requires a global strategy consisting of combined and long-term interventions: prevention, outreach, screening, DAA, drug treatment programs including opiate substitution treatment (OST) and various harm reduction programs, including needle exchange programs (NEP). Ideally, these services should be delivered in the same place with an integrated approach. This should lead to meeting the national objective set by the government of eliminating hepatitis C by 2025.
2016年5月25日法国取消丙型肝炎治疗报销限制后，一份专家报告提出了相关建议，这些建议聚焦于包括注射吸毒者在内的弱势群体。本评论阐述了该章节的要点，尤其侧重于政策方面。由于基于疾病阶段的限制正式解除，以及新型直接作用抗病毒药物（DAA）在注射吸毒者中具有出色的疗效和耐受性，主要问题在于改善丙型肝炎的治疗流程。在法国，许多感染丙型肝炎的注射吸毒者，尤其是仍在活跃注射的吸毒者，仍未得到诊断且未与医疗服务建立联系。我们面临的挑战是通过即时检测（POCT）、流动团队的外展方法、快速检测、FibroScan等手段改善丙型肝炎筛查，并在注射吸毒者前往的所有场所，如戒毒治疗或减少伤害服务机构、社会服务机构、监狱等，为他们提供适当的服务。另一个重要问题是通过全面和长期的随访预防再次感染。该报告建议制定一项新的国家政策：将检测和治疗注射吸毒者作为优先事项，因为这是消除丙型肝炎感染的最佳方式。这需要一项由联合和长期干预措施组成的全球战略：预防、外展、筛查、DAA、包括阿片类药物替代治疗（OST）在内的戒毒治疗项目以及各种减少伤害项目，包括针头交换项目（NEP）。理想情况下，这些服务应以综合方式在同一地点提供。这应有助于实现政府设定的到2025年消除丙型肝炎的国家目标。
