Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.
Kirby Institute, UNSW Sydney, Sydney, Australia.
Drug Alcohol Rev. 2019 Feb;38(2):185-189. doi: 10.1111/dar.12903. Epub 2019 Feb 13.
To maximise the benefits of direct acting antivirals in Australia, innovative options for marginalised populations to receive daily or weekly medication may be beneficial. This study evaluated the feasibility and acceptability of direct acting antivirals provision by leveraging an opioid agonist treatment program to support adherence regardless of opioid agonist treatment enrolment.
Feasibility was evaluated by monitoring selection of dosing options by clients initiating direct acting antivirals during the first 6 months. Client acceptability was assessed using a cross-sectional survey after 6 months. Pre- and post-implementation surveys of attitudes and concerns regarding the program were compared to evaluate staff acceptability.
Among 79 clients commencing direct acting antivirals, 30 (38%) chose adherence support. Among these, 12 (40%) were not simultaneously enrolled in opioid agonist treatment. Clients were satisfied with service provision and access despite introducing daily dosing. All highly marginalised clients receiving direct acting antivirals with adherence support found this helpful. Staff concerns identified prior to the program proved unfounded.
This study demonstrates providing adherence support for direct acting antivirals regardless of client participation in opioid agonist treatment is both feasible and acceptable with minimal impact on service provision. Availability of direct acting antivirals in opioid agonist treatment or primary health-care settings expands the pool of people who may receive effective treatment for hepatitis C virus and reduces treatment barriers.
为了在澳大利亚最大限度地发挥直接作用抗病毒药物的益处，为边缘化人群提供获得每日或每周药物的创新选择可能是有益的。本研究通过利用阿片类药物激动剂治疗方案来支持依从性，无论是否接受阿片类药物激动剂治疗，从而评估了为边缘化人群提供直接作用抗病毒药物的可行性和可接受性。
通过监测在头 6 个月内开始使用直接作用抗病毒药物的患者选择剂量方案来评估可行性。在 6 个月后进行横断面调查评估患者的可接受性。通过比较实施前后对该方案的态度和担忧的调查来评估工作人员的可接受性。
在开始使用直接作用抗病毒药物的 79 名患者中，有 30 名（38%）选择了依从性支持。其中，有 12 名（40%）未同时接受阿片类药物激动剂治疗。尽管引入了每日剂量，患者对服务提供和获得仍然感到满意。所有接受直接作用抗病毒药物治疗且接受依从性支持的高度边缘化患者都认为这很有帮助。在该方案实施前确定的工作人员担忧被证明是没有根据的。
本研究表明，无论患者是否参与阿片类药物激动剂治疗，提供直接作用抗病毒药物的依从性支持都是可行且可接受的，对服务提供的影响很小。在阿片类药物激动剂治疗或基层医疗保健环境中提供直接作用抗病毒药物可扩大可能接受丙型肝炎病毒有效治疗的人群，并减少治疗障碍。
