Australasian Society for HIV, Viral Hepatitis, and Sexual Health Medicine, Sydney, New South Wales, Australia.
National Viral Hepatitis Roundtable, Washington, DC, United States.
Int J Drug Policy. 2019 Apr;66:87-93. doi: 10.1016/j.drugpo.2019.01.012. Epub 2019 Feb 8.
It is estimated that 6.1 million people with recent injecting drug use (PWID) are living with hepatitis C virus (HCV). Although HCV-related morbidity and mortality among PWID continues to increase, the advent of direct acting antiviral (DAA) HCV regimens with cure rates >95% provides an opportunity to reverse the rising burden of disease. Additionally, given evidence that opioid substitution therapy and high-coverage needle and syringe programs can reduce HCV incidence by up to 80%, there is an opportunity to reduce HCV transmission with increased coverage of harm reduction services. However, there are significant patient, provider, health system, structural, and societal barriers that impede access to HCV prevention and care for PWID. The International Network on Hepatitis in Substance Users (INHSU), in collaboration with the Australasian Society for HIV, Viral Hepatitis, Sexual Health Medicine (ASHM), Harm Reduction International, the Canadian Network on Hepatitis C, Canadian Research Initiative in Substance Misuse, the National Viral Hepatitis Roundtable, Médecins du Monde and CATIE, held a roundtable discussion prior to the Harm Reduction Conference in Montreal, Canada on 13th May 2017 to discuss how to improve HCV prevention and care for PWID. Over 100 international researchers, practitioners, policy makers, advocates, and affected community members came together to discuss shared priorities for action, develop actionable next steps and to create partnerships to enable application of priorities. This paper highlights the key priority areas identified by participants including: enhancing global coverage of harm reduction services; addressing punitive drug policies; ensuring access to affordable HCV diagnostics and treatment; improving the evidence-base for HCV prevention, testing, linkage to care and treatment; implementing integrated HCV programs; advancing peer-based models of HCV care; and tackling social determinants of health inequalities for PWID. This paper also highlights the recommended actions for each priority identified by the participants from this roundtable.
据估计，有 610 万最近有注射吸毒行为的人（PWID）携带丙型肝炎病毒（HCV）。尽管 PWID 中与 HCV 相关的发病率和死亡率继续上升，但治愈率>95%的直接作用抗病毒（DAA）HCV 方案的出现提供了一个扭转疾病负担上升的机会。此外，鉴于阿片类药物替代疗法和高覆盖率的针具和注射器方案可以将 HCV 发病率降低多达 80%，因此，通过增加减少伤害服务的覆盖率，有机会减少 HCV 传播。然而，PWID 获得 HCV 预防和护理存在重大的患者、提供者、卫生系统、结构性和社会障碍。国际药物使用者肝炎网络（INHSU）与澳大拉西亚艾滋病毒、病毒性肝炎、性健康医学协会（ASHM）、减少伤害国际、加拿大丙型肝炎网络、加拿大药物滥用研究倡议、国家病毒性肝炎圆桌会议、无国界医生组织和 CATIE 合作，于 2017 年 5 月 13 日在加拿大蒙特利尔举行的减少伤害会议之前举行了一次圆桌讨论，讨论如何改善 PWID 的 HCV 预防和护理。超过 100 名国际研究人员、从业者、政策制定者、倡导者和受影响的社区成员聚集在一起，讨论共同的行动重点，制定可行的下一步措施，并建立伙伴关系，以实施这些优先事项。本文重点介绍了与会者确定的关键优先领域，包括：加强全球减少伤害服务的覆盖范围；解决惩罚性毒品政策；确保负担得起的 HCV 诊断和治疗的可及性；改善 HCV 预防、检测、与护理和治疗的联系的证据基础；实施综合 HCV 方案；推进基于同伴的 HCV 护理模式；以及解决 PWID 的健康不平等的社会决定因素。本文还重点介绍了与会者从本次圆桌会议为每个优先事项确定的建议行动。
