Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, 3086, Victoria, Australia; Centre for Social Research in Health, University of New South Wales, UNSW Sydney, NSW 2052, Australia; STI and BBV Applied Research and Evaluation Network, School of Public Health, Curtin University, GPO Box U1987, Perth WA 6845, Australia.
Peer-based Harm Reduction WA, PO Box 8003, Perth WA 6849, Australia.
Int J Drug Policy. 2019 Oct;72:24-32. doi: 10.1016/j.drugpo.2019.05.025. Epub 2019 Jun 5.
Achieving hepatitis C (HCV) elimination goals will require major policy and health service reorientation to scale up testing and treatment among people who inject drugs (PWID). To achieve this, a close partnership with peer-based drug user organisations is required. However, peer organisations have historical and ongoing difficulties in articulating the validity of their service delivery and policy advice, leading to some policy and health services resisting partnership and advice from peer-based drug user organisations.
To develop a deeper understanding of the role of peer-based drug user organisations in the HCV response, we analysed data from the W3 Project which used systems thinking methods to draw together the insights of over 90 peer staff from 10 Australian community and peer organisations in HCV and HIV. The resulting system maps were analysed to identify system dynamics and functions that need to be fulfilled for peer organisations to be influential within their community and policy system.
We identified the interactions at a system level which can enhance or constrain the quality and influence of policy advice from peer-based drug user organisations. We found the strength of Peer-based drug user organisations to support the scale up of HCV testing and treatment was their capacity to mediate between, and navigate within, the complex community and policy/health service systems. While peer-based drug user organisations endeavour to demonstrate their capacity and credibility in terms of engagement, alignment, adaptation and influence, policy and service organisations also need recognise their own system role to value and enable peer-based drug user organisations to achieve their potential.
If the HCV prevention and treatment system is to reach PWID living with HCV and achieve HCV elimination goals, then policy and health services need to invest in strengthening peer-based drug user organisations as well as recognise, value and act on quality policy advice from PWID peer leadership.
要实现消除丙型肝炎（HCV）的目标，就必须对政策和卫生服务进行重大调整，扩大对吸毒者（PWID）的检测和治疗。要实现这一目标，就需要与基于同伴的吸毒者组织建立密切的伙伴关系。然而，同伴组织在说明其服务提供和政策建议的有效性方面一直存在历史和持续的困难，导致一些政策和卫生服务抵制与基于同伴的吸毒者组织建立伙伴关系和接受其建议。
为了更深入地了解基于同伴的吸毒者组织在 HCV 应对中的作用，我们分析了 W3 项目的数据，该项目采用系统思维方法汇集了来自澳大利亚 10 个社区和同伴组织的 90 多名同伴工作人员在 HCV 和 HIV 方面的见解。对生成的系统图进行了分析，以确定同伴组织在其社区和政策系统中发挥影响力所需满足的系统动态和功能。
我们确定了可以增强或限制基于同伴的吸毒者组织的政策建议的质量和影响力的系统层面的相互作用。我们发现，基于同伴的吸毒者组织支持 HCV 检测和治疗规模扩大的优势在于其在复杂的社区和政策/卫生服务系统中进行调解和导航的能力。虽然基于同伴的吸毒者组织努力在参与、一致性、适应性和影响力方面展示其能力和可信度，但政策和服务组织也需要认识到自己的系统角色，重视并使基于同伴的吸毒者组织能够发挥其潜力。
如果 HCV 预防和治疗系统要接触到携带 HCV 的吸毒者并实现消除 HCV 的目标，那么政策和卫生服务部门就需要投资于加强基于同伴的吸毒者组织，同时承认、重视并根据吸毒者同伴领导提供的高质量政策建议采取行动。
