针对注射毒品人群中推迟 HCV 治疗的叙事内容，提供基于证据和指南一致的应对措施。
Evidence-based and guideline-concurrent responses to narratives deferring HCV treatment among people who inject drugs.
机构信息
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
出版信息
Harm Reduct J. 2019 Feb 11;16(1):14. doi: 10.1186/s12954-019-0286-6.
BACKGROUND
Hepatitis C virus (HCV) infection is increasingly prevalent among people who inject drugs (PWID) in the context of the current US opioid crisis. Although curative therapy is available and recommended as a public health strategy, few PWID have been treated. We explore PWID narratives that explain why they have not sought HCV treatment or decided against starting it. We then compare these narratives to evidence-based and guideline-concordant information to better enable health, social service, harm reduction providers, PWID, and other stakeholders to dispel misconceptions and improve HCV treatment uptake in this vulnerable population.
METHODS
We recruited HIV-uninfected PWID (n = 33) through community-based organizations (CBOs) to participate in semi-structured, in-depth qualitative interviews on topics related to overall health, access to care, and knowledge and interest in specific HIV prevention methods.
RESULTS
In interviews, HCV transmission and delaying or forgoing HCV treatment emerged as important themes. We identified three predominant narratives relating to delaying or deferring HCV treatment among PWID: (1) lacking concern about HCV being serious or urgent enough to require treatment, (2) recognizing the importance of treatment but nevertheless deciding to delay treatment, and (3) perceiving that clinicians and insurance companies recommend that patients who currently use or inject drugs should delay treatment.
CONCLUSIONS
Our findings highlight persistent beliefs among PWID that hinder HCV treatment utilization. Given the strong evidence that treatment improves individual health regardless of substance use status while also decreasing HCV transmission in the population, efforts are urgently needed to counter the predominant narratives identified in our study. We provide evidence-based, guideline-adherent information that counters the identified narratives in order to help individuals working with PWID to motivate and facilitate treatment access and uptake. An important strategy to improve HCV treatment initiation among PWID could involve disseminating guideline-concordant counternarratives to PWID and the providers who work with and are trusted by this population.
背景
在当前美国阿片类药物危机背景下，丙型肝炎病毒（HCV）感染在注射毒品者（PWID）中越来越普遍。尽管有有效的治疗方法，并且被推荐作为公共卫生策略，但很少有 PWID 接受治疗。我们探讨了 PWID 的叙述，以解释他们为什么没有寻求 HCV 治疗或决定不开始治疗。然后，我们将这些叙述与基于证据和符合指南的信息进行比较，以便更好地使卫生、社会服务、减少伤害提供者、PWID 和其他利益相关者能够消除误解，提高这一弱势群体的 HCV 治疗率。
方法
我们通过社区组织（CBO）招募了 HIV 未感染的 PWID（n=33），让他们参与与整体健康、获得医疗服务以及对特定 HIV 预防方法的知识和兴趣相关的半结构化深入定性访谈。
结果
在访谈中，HCV 传播和延迟或放弃 HCV 治疗成为重要主题。我们确定了与 PWID 延迟或推迟 HCV 治疗相关的三个主要叙述：（1）缺乏对 HCV 严重程度或紧迫性的关注，认为不需要治疗；（2）认识到治疗的重要性，但仍决定延迟治疗；（3）认为临床医生和保险公司建议目前使用或注射毒品的患者应延迟治疗。
结论
我们的研究结果突出了 PWID 中存在的阻碍 HCV 治疗利用的持续信念。鉴于治疗无论在药物使用状况如何都能改善个体健康，同时也能减少人群中的 HCV 传播，因此迫切需要努力反驳我们研究中确定的主要叙述。我们提供基于证据和符合指南的信息，反驳已确定的叙述，以帮助与 PWID 一起工作的个人激发和促进他们获得和接受治疗。提高 PWID 中 HCV 治疗起始率的一个重要策略是向 PWID 和为该人群提供服务并受到他们信任的提供者传播符合指南的反叙述。
Zotero 插件