The Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, Australia.
Central Clinical School, University of Sydney and Drug Health Services, Sydney Local Health District, Sydney, Australia.
Drug Alcohol Rev. 2019 Feb;38(2):177-184. doi: 10.1111/dar.12895. Epub 2019 Jan 16.
Increasing treatment uptake among people who inject drugs (PWID) with chronic hepatitis C virus (HCV) infection is integral to eliminating viral hepatitis. This study explored the role of community-based outreach in engaging and retaining Australian PWID in the testing component of the HCV care cascade.
Semi-structured interviews were conducted with 28 PWID, including new initiates to injecting and those from culturally and linguistically diverse (CALD) backgrounds, who acquired HCV infection while enrolled in a community-based prospective observational study of hepatitis C vaccine preparedness in Sydney. Participants were interviewed at diagnosis and 12 months later. Transcripts were thematically analysed using constant comparative techniques.
Community-based outreach was effective in engaging newly infected participants in HCV monitoring and decision-making about seeking interferon-based treatment. Key factors in the acceptability of outreach were privacy and discretion, and opportunities to build trust with non-judgmental staff. Retaining participants in the HCV cascade of care required more than a one-off session of post-test counselling. Ongoing discussions with staff enabled paced and tailored delivery of information about HCV prevention, testing and treatment. Increased understanding of the role of HCV ribonucleic acid viremia in determining the need for treatment, and access to this testing, was pivotal in making HCV monitoring salient for participants.
Outreach is an effective strategy for engaging new initiates to injecting and CALD PWID in HCV testing and decision-making about treatment. Findings highlight the need to increase availability and access to HCV ribonucleic acid testing for PWID.
提高慢性丙型肝炎病毒（HCV）感染的注射吸毒者（PWID）的治疗率是消除病毒性肝炎的关键。本研究探讨了社区外展在参与和留住澳大利亚 PWID 接受 HCV 护理级联检测部分的作用。
对 28 名 PWID 进行了半结构化访谈，包括新开始注射和来自文化和语言多样化（CALD）背景的人，他们在悉尼的丙型肝炎疫苗准备社区前瞻性观察研究中感染了 HCV。参与者在诊断时和 12 个月后接受了访谈。使用恒定性比较技术对转录本进行主题分析。
社区外展在 HCV 监测和寻求干扰素治疗方面，有效地使新感染的参与者参与进来并做出决策。外展可接受性的关键因素是隐私和谨慎，以及与非评判性工作人员建立信任的机会。在 HCV 护理级联中留住参与者需要不仅仅是一次性的测试后咨询。与工作人员的持续讨论使 HCV 预防、检测和治疗方面的信息能够有节奏地、量身定制地传递。参与者对 HCV 核糖核酸病毒血症在确定治疗需求和获得该检测方面的作用的理解加深，对于 HCV 监测的重要性至关重要。
外展是一项有效的策略，可以使新开始注射和 CALD PWID 参与 HCV 检测，并对治疗做出决策。研究结果强调了需要增加 PWID 获得 HCV 核糖核酸检测的机会。
