National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
Drug Alcohol Rev. 2019 Mar;38(3):264-269. doi: 10.1111/dar.12883. Epub 2018 Dec 12.
Direct acting antiviral (DAA) treatment can reduce hepatitis C virus (HCV) infection incidence and mortality, although large scale uptake of these treatments is necessary to achieve those reductions. Targeting people who inject drugs (PWID) will be crucial to achieve the necessary reductions. Previously, treatment uptake has been very low (1-2%) among PWID, but these new DAAs have been subsidised in Australia since March 2016. This study describes treatment uptake among a sample of PWID in Australia and examines sociodemographic and drug use variables associated with treatment uptake.
An Australian national cross-sectional sample (n = 817) of regular PWID drawn from a convenience sentinel sample aged ≥18 years. Information on demographics, drug use, HCV antibody testing, RNA testing, recent DAA treatment initiation and DAA prescriber settings was collected via an interviewer-administered survey.
There were 291 HCV RNA positive participants, of who one-third reported initiating DAA treatment since the introduction of subsidised DAA medications. Current opioid substitution treatment was significantly associated with increased treatment uptake (adjusted odds ratio 2.20, 95% confidence interval 1.31, 3.68) while those with unstable housing were less likely to initiate treatment (adjusted odds ratio 0.42, 95% confidence interval 0.22, 0.82).
This study found that DAA treatment uptake has increased among current PWID, a priority population for treatment. Efforts to maintain this uptake through linking current PWID with treatment providers through harm reduction services such as opioid substitution therapy, needle and syringe programs, and outreach services are required to meet incidence and mortality reduction targets.
直接作用抗病毒（DAA）治疗可以降低丙型肝炎病毒（HCV）感染的发病率和死亡率，尽管需要大规模采用这些治疗方法才能实现这些降低。针对注射吸毒者（PWID）将是实现必要降低的关键。以前，PWID 中的治疗接受率非常低（1-2%），但自 2016 年 3 月以来，澳大利亚已经对这些新的 DAA 进行了补贴。本研究描述了澳大利亚一组 PWID 中的治疗接受情况，并检查了与治疗接受相关的社会人口统计学和药物使用变量。
从年龄≥18 岁的便利哨点样本中抽取了澳大利亚全国性的横断面样本（n = 817），定期使用 PWID。通过访谈者管理的调查收集了关于人口统计学、药物使用、HCV 抗体检测、RNA 检测、最近 DAA 治疗开始和 DAA 处方者设置的信息。
有 291 名 HCV RNA 阳性参与者，其中三分之一报告自补贴 DAA 药物推出以来开始接受 DAA 治疗。目前接受阿片类药物替代治疗与增加治疗接受率显著相关（调整后的优势比 2.20，95%置信区间 1.31，3.68），而不稳定住房的人更不可能开始治疗（调整后的优势比 0.42，95%置信区间 0.22，0.82）。
本研究发现，当前 PWID 的 DAA 治疗接受率有所增加，PWID 是治疗的优先人群。需要通过减少伤害服务（如阿片类药物替代治疗、针具和注射器计划以及外展服务）将当前的 PWID 与治疗提供者联系起来，以保持这种接受率，从而实现发病率和死亡率降低的目标。
