Roncero Carlos, Ryan Pablo, Littlewood Richard, Macías Juan, Ruiz Juan, Seijo Pedro, Palma-Álvarez Raúl Felipe, Vega Pablo
Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain,
Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.
Hepat Med. 2018 Dec 24;11:1-11. doi: 10.2147/HMER.S187133. eCollection 2019.
People with a history of injecting drugs have high prevalence of hepatitis C virus (HCV) infection, and many have opioid use disorder (OUD). Modern HCV therapies with improved efficacy and tolerability are available, but access is often limited for this group, who may be underserved for health care and face social inequity. This work develops practical steps to improve HCV care in this population.
Practical steps to improve HCV care in OUD populations were developed based on clinical experience from Spain, structured assessment of published evidence.
Options for improving care at engagement/screening stages include patient education programs, strong provider-patient relationship, peer support, and adoption of rapid effective screening tools. To facilitate work up/treatment, start options include simplified work up process, integration of HCV and OUD care, and continuous psychosocial support prior, during, and after HCV treatment.
It is important to plan on local basis to set up a joint integrated approach between specific drug treatment services and local points of HCV care. The elements for a specific integrated program should be chosen from options identified, including education services, peer input, organization to make HCV screening and treatment easier by co-location of services, and wider access to prescribing direct-acting antiviral (DAA) therapy.
有注射吸毒史的人群丙型肝炎病毒（HCV）感染率很高，且许多人患有阿片类物质使用障碍（OUD）。目前已有疗效和耐受性得到改善的现代HCV治疗方法，但该群体往往难以获得这些治疗，他们可能在医疗保健方面未得到充分服务，且面临社会不平等问题。这项工作制定了改善该人群HCV治疗的实际步骤。
基于西班牙的临床经验以及对已发表证据的结构化评估，制定了改善OUD人群HCV治疗的实际步骤。
在参与/筛查阶段改善治疗的选项包括患者教育项目、牢固的医患关系、同伴支持以及采用快速有效的筛查工具。为促进检查/治疗，起始选项包括简化检查流程、整合HCV和OUD治疗以及在HCV治疗前、治疗期间和治疗后提供持续的心理社会支持。
在当地规划建立特定药物治疗服务与当地HCV治疗点之间的联合综合方法很重要。特定综合项目的要素应从已确定的选项中选择，包括教育服务、同伴意见、通过服务同址设置使HCV筛查和治疗更便捷的组织安排，以及更广泛地获得直接作用抗病毒药物（DAA）治疗的处方。
