The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
J Viral Hepat. 2020 Mar;27(3):281-293. doi: 10.1111/jvh.13233. Epub 2019 Dec 6.
Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole-blood samples for dried blood spot, Xpert HCV Viral Load and venepuncture samples. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre-DAA era to 38% in the DAA era. Significant liver fibrosis (F2-F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88; 95% CI, 1.18-7.04) and attending a clinical follow-up with nurse (aOR, 3.19; 95% CI, 1.61-6.32) or physician (aOR, 11.83; 95% CI, 4.89-28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.
在注射毒品者（PWID）中，丙型肝炎病毒（HCV）检测、诊断、肝病评估和治疗的差距仍然存在。我们旨在描述澳大利亚 PWID 中 HCV 护理的连续过程，即在不受限制地获得直接作用抗病毒（DAA）治疗之前和之后。2014 年至 2018 年间，参与者参加了一项观察性队列研究，提供了指尖全血样本用于干血斑、Xpert HCV 病毒载量和静脉血样。参与者接受了瞬时弹性成像和护士或全科医生的临床评估。在 839 名参与者（平均年龄 43 岁）中，66%为男性（n=550），64%（n=537）在过去一个月内注射毒品，67%（n=560）报告目前正在接受阿片类药物替代治疗。总体而言，45%（n=380）的 HCV RNA 可检测，其中 23%（n=86）在登记后 12 个月内接受 HCV 治疗。HCV 治疗的采用率从 DAA 前时代的 2%增加到 DAA 时代的 38%。感染 HCV 的参与者（38%）比未感染者（19%）更常见出现显著的肝纤维化（F2-F4）。年龄 50 岁或以上（优势比，2.88；95%置信区间，1.18-7.04）和接受护士（优势比，3.19；95%置信区间，1.61-6.32）或医生（优势比，11.83；95%置信区间，4.89-28.59）的临床随访与 HCV 治疗的采用相关。最近的注射吸毒和不稳定的住房与 HCV 治疗的采用无关。在 DAA 时代，PWID 中 HCV 治疗的采用率显著增加。需要评估创新和简化的护理模式，以进一步提高治疗的采用率。
