Wallace Jack, Hanley Bev, Belfrage Mary, Gregson Sandra, Quiery Niall, Lucke Jayne
Burnet Institute, 185 Commercial Road, Melbourne, Vic. 3004, Australia.
Deceased. Victorian Aboriginal Health Service, 186 Nicholson Street, Fitzroy, Vic. 3065, Australia.
Aust J Prim Health. 2018 Jan;24(6):491-495. doi: 10.1071/PY18024.
Aboriginal and Torres Strait Islander peoples are disproportionately affected by hepatitis C, an infection that is curable with direct acting antivirals (DAAs). The Australian Government funded access to DAAs from March 2016 for all people with hepatitis C, with primary care physicians, along with clinical specialists, permitted to prescribe these treatments. The Victorian Aboriginal Health Service, in recognising the effect of liver disease from viral hepatitis within their community, and of the increased availability to DAAs, established a Liver Clinic to facilitate access to treatment for people attending the service. This study conducted semi-structured interviews to document the health service provider perspectives on the barriers and enablers to treatment; explored patients' experiences of hepatitis C treatment and cure; and sought to identify possible health system-level changes to facilitate increased access and uptake of treatment by Aboriginal people. The study found the success of the clinic was supported by the multidisciplinary and accessible nature of the health service, and the relationships built over time between clinic staff and people with, or at risk of, hepatitis C. For those treated, the individual effect of the cure not only eliminated the hepatitis C virus, but reduced shame and increased broader social participation.
澳大利亚原住民和托雷斯海峡岛民受丙型肝炎的影响尤为严重,而这种感染可以通过直接作用抗病毒药物(DAA)治愈。自2016年3月起,澳大利亚政府为所有丙型肝炎患者提供DAA药物,初级保健医生以及临床专家均可开具这些治疗药物。维多利亚原住民健康服务机构认识到病毒性肝炎导致的肝脏疾病对其社区的影响,以及DAA药物可及性的提高,因此设立了肝脏诊所,以便为前来就诊的患者提供治疗途径。本研究通过半结构化访谈记录了医疗服务提供者对治疗障碍和促进因素的看法;探讨了患者丙肝治疗和治愈的经历;并试图确定可能的卫生系统层面的变革,以促进原住民增加治疗的可及性和接受度。研究发现,该诊所的成功得益于医疗服务的多学科性质和可及性,以及诊所工作人员与丙型肝炎患者或有感染风险者之间长期建立的关系。对于接受治疗的患者而言,治愈的个体效果不仅消除了丙型肝炎病毒,还减轻了羞耻感,并增加了更广泛的社会参与度。