Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2(nd) Floor, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA, USA.
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA, USA.
Drug Alcohol Depend. 2021 Mar 1;220:108526. doi: 10.1016/j.drugalcdep.2021.108526. Epub 2021 Jan 11.
The US opioid crisis is associated with a surge in hepatitis C virus (HCV) infections among persons who inject drugs (PWID), and yet the uptake of HCV curative therapy among PWID is low.
To explore potential solutions to overcome barriers to HCV treatment uptake among individuals at a drug detoxification center.
Qualitative study with in-depth interviews and thematic analysis of coded data.
Patients (N = 24) had the following characteristics: mean age 37 years; 67 % White, 13 % Black, 8 % Latinx, 4 % Native Hawaiian/Pacific Islander, 8 % other; 71 % with a history of injecting drugs. Most patients with a positive HCV test had not pursued treatment due to few perceived immediate consequences from a positive test and possible complications arising in a distant poorly imagined future. Active substance use was a major barrier to HCV treatment uptake because of disruptions to routine activities. In addition, re-infection after treatment was perceived as inevitable. Patients had suggestions to improve HCV treatment uptake: high-intensity wraparound care characterized by frequent interactions with supportive services; same-day/walk-in options; low-barrier access to substance use treatment; assistance with navigating the health care system; attention to immediate needs, such as housing; and the opportunity to select an approach that best fits individual circumstances.
Active substance use was a major barrier to treatment initiation. To improve uptake, affected individuals recommended that HCV treatment be integrated within substance use treatment programs. Such a model should incorporate patient education within low-barrier, high-intensity wraparound care, tailored to patients' needs and priorities.
美国阿片类药物危机与注射毒品者（PWID）中丙型肝炎病毒（HCV）感染的激增有关，而 PWID 接受 HCV 治愈性治疗的比例很低。
探索克服药物解毒中心个体接受 HCV 治疗障碍的潜在解决方案。
采用深入访谈和编码数据的主题分析的定性研究。
患者（N=24）具有以下特征：平均年龄 37 岁；67%为白人，13%为黑人，8%为拉丁裔，4%为夏威夷/太平洋岛民，8%为其他；71%有注射毒品史。大多数 HCV 检测呈阳性的患者没有接受治疗，原因是他们认为阳性检测结果没有立即产生影响，并且未来可能会出现难以想象的并发症。由于常规活动受到干扰，药物滥用是接受 HCV 治疗的主要障碍。此外，治疗后再次感染被认为是不可避免的。患者提出了改善 HCV 治疗接受度的建议：以与支持性服务频繁互动为特征的高强度综合关怀；当天/即到即得服务；接受物质使用治疗的低门槛；帮助患者了解医疗保健系统；关注即时需求，如住房；并提供机会选择最适合个人情况的方法。
药物滥用是治疗启动的主要障碍。为了提高接受度，受影响的个人建议将 HCV 治疗纳入物质使用治疗计划。这种模式应将患者教育纳入低门槛、高强度的综合关怀中，以满足患者的需求和优先事项。
