British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616911320, Iran.
Int J Drug Policy. 2019 Oct;72:146-159. doi: 10.1016/j.drugpo.2019.05.023. Epub 2019 May 27.
Despite the key role that people who inject drugs (PWID) play in the hepatitis C virus (HCV) epidemic, HCV treatment rates among this population have been historically low. Integrated models of HCV and substance use care have the potential to overcome some barriers to access; however, the evidence base is uncertain. This systematic review assesses the impacts of integrated HCV and substance use services on engagement in HCV care among PWID.
We searched five databases up to December 2018 to identify original quantitative studies evaluating the impacts of co-location of HCV and substance use services on engagement in the HCV cascade of care among adult PWID. We conducted a narrative synthesis, categorizing models based on patient entry point (a: HCV facility, b: substance use disorder (SUD) facility, and c: other facilities), and levels of integrated services offered (a: HCV/substance use testing only, b: HCV/substance use treatment, and c: testing/treatment + other services).
A total of 46 articles corresponding to 44 original studies were included. Almost all studies (n = 42) were conducted in high-income countries and only six studies in the Direct-Acting Antiviral (DAA) era. Twenty-six studies discussed the integration of services at SUD facilities, one at HCV facilities, and seventeen at other facilities. Analysis of included studies indicated that overall integrated care resulted in improved engagement in HCV care (e.g., testing, treatment uptake and cure). However, the quality of evidence was predominantly low to moderate.
Available evidence suggests that integration of HCV and substance use services may improve engagement along the continuum of HCV care among PWID. Given limitations in data quality, and very few studies conducted in the DAA era and in low- and middle-income settings, further research is urgently needed to inform strategies to optimize HCV care access and outcomes among PWID globally.
尽管注射毒品者（PWID）在丙型肝炎病毒（HCV）流行中起着关键作用，但该人群的 HCV 治疗率历来较低。HCV 和物质使用护理的综合模式有可能克服一些获得护理的障碍；然而，证据基础不确定。本系统评价评估了综合 HCV 和物质使用服务对 PWID 参与 HCV 护理的影响。
我们搜索了五个数据库，截至 2018 年 12 月，以确定评估 HCV 和物质使用服务共同定位对成年 PWID 参与 HCV 护理级联影响的原始定量研究。我们进行了叙述性综合，根据患者进入点（a：HCV 设施，b：物质使用障碍（SUD）设施和 c：其他设施）和提供的综合服务水平（a：HCV/物质使用测试仅，b：HCV/物质使用治疗和 c：测试/治疗+其他服务）对模型进行分类。
共纳入 46 篇文章，对应 44 项原始研究。几乎所有研究（n=42）均在高收入国家进行，只有 6 项研究在直接作用抗病毒（DAA）时代进行。26 项研究讨论了 SUD 设施的服务整合，1 项在 HCV 设施，17 项在其他设施。纳入研究的分析表明，整体综合护理可提高 HCV 护理的参与度（例如，检测、治疗采用率和治愈率）。然而，证据质量主要为低至中度。
现有证据表明，HCV 和物质使用服务的整合可能会改善 PWID 中 HCV 护理连续体的参与度。鉴于数据质量的局限性，以及在 DAA 时代和中低收入国家进行的研究非常有限，迫切需要进一步研究，为优化全球 PWID 的 HCV 护理获得和结果提供信息。
