Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
National Addiction Centre, Kings College London, London, United Kingdom.
PLoS One. 2018 Nov 30;13(11):e0207226. doi: 10.1371/journal.pone.0207226. eCollection 2018.
Recent advances in the efficacy and tolerability of hepatitis C treatments and the introduction of a universal access scheme for the new Direct Acting Antiviral (DAA) therapies in March 2016, has resulted in a rapid increase in the uptake of hepatitis C treatment in Australia. Despite these positive developments, recent data suggest a plateauing of treatment numbers, indicating that more work may need to be done to identify and address ongoing barriers to hepatitis C treatment access and uptake. This paper aims to contribute to our understanding of the ongoing barriers to DAA therapies, with a focus on people who inject drugs. The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process. The study's findings show that residual barriers to DAA treatment exist at personal, provider and system levels and include poor venous access, DAA treatments not considered 'core-business' by opioid substitution treatment (OST) providers, and patients having to manage multiple health and social priorities that interfere with keeping medical appointments such as childcare and poor access to transport services. Further, efforts to increase access to and uptake of DAA hepatitis C treatment over time will require a focus on reducing stigma and discrimination towards people who inject drugs as this remains as a major barrier to care for many people.
近年来,丙型肝炎治疗的疗效和耐受性取得了进展,加上 2016 年 3 月新的直接作用抗病毒药物(DAA)治疗方案的普及,澳大利亚丙型肝炎治疗的采用率迅速提高。尽管有这些积极的发展,但最近的数据表明治疗人数趋于平稳,这表明可能需要做更多的工作来确定和解决丙型肝炎治疗机会和采用方面的持续障碍。本文旨在增进我们对 DAA 治疗持续存在的障碍的理解,重点关注注射毒品的人。本文借鉴了一项基于参与式研究设计的定性研究中参与者访谈数据,该研究设计包括一名在研究过程的各个阶段都具有丙型肝炎 DAA 治疗和注射毒品使用直接经验的同伴研究人员。研究结果表明,DAA 治疗在个人、提供者和系统层面上仍然存在残余障碍,包括静脉通路不良、阿片类药物替代治疗(OST)提供者不认为 DAA 治疗是“核心业务”,以及患者必须管理多个健康和社会优先事项,这些事项会干扰他们按时就医,如照顾孩子和获得交通服务的机会差。此外,随着时间的推移,要增加 DAA 丙型肝炎治疗的机会和采用率,就需要重点减少对注射毒品者的污名和歧视,因为这仍然是许多人接受护理的主要障碍。
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