Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
Public Health Scotland, Glasgow, UK.
Addiction. 2021 Oct;116(10):2893-2907. doi: 10.1111/add.15459. Epub 2021 May 5.
BACKGROUND AND AIMS: There has been little empirical evidence to show the 'real-world' impact of scaling-up direct-acting anti-viral (DAA) treatment among people who inject drugs (PWID) on hepatitis C virus (HCV) viraemia at a population level. We aimed to assess the population impact of rapid DAA scale-up to PWID delivered through community services-including drug treatment, pharmacies, needle exchanges and prisons-in the Tayside region of Scotland, compared with Greater Glasgow and Clyde (GGC) and the Rest of Scotland (RoS). DESIGN, SETTING AND PARTICIPANTS: Natural experiment, evaluated using data from national biennial surveys of PWID and national clinical data. Services providing injecting equipment (2010-18) and HCV treatment clinics (2017-18) across Scotland. A total of 12 492 PWID who completed a questionnaire and provided a blood spot (tested for HCV-antibodies and RNA); 4105 individuals who initiated HCV treatment. INTERVENTION AND COMPARATOR, MEASUREMENTS: The intervention was rapid DAA scale-up among PWID, which occurred in Tayside. The comparator was GGC/RoS. Trends in HCV viraemia and uptake of HCV therapy over time; sustained viral response (SVR) rates to therapy by region and treatment setting. FINDINGS: Uptake of HCV therapy (last year) among PWID between 2013-14 and 2017-18 increased from 15 to 43% in Tayside, 6 to 16% in GGC and 11 to 23% in RoS. Between 2010 and 2017-18, the prevalence of HCV viraemia (among antibody-positives) declined from 73 to 44% in Tayside, 67 to 58% in GGC and 64 to 55% in RoS. The decline in viraemia was greater in Tayside [2017-18 adjusted odds ratio (aOR) = 0.47, 95% confidence interval (CI) = 0.30-0.75, P = 0.001] than elsewhere in Scotland (2017-18 aOR = 0.89, 95% CI = 0.74-1.07, P = 0.220) relative to the baseline of 2013-14 in RoS (including GGC). Per-protocol SVR rates among PWID treated in community sites did not differ from those treated in hospital sites in Tayside (97.4 versus 100.0%, P = 0.099). CONCLUSIONS: Scale-up of direct-acting anti-viral treatment among people who inject drugs can be achieved through hepatitis C virus (HCV) testing and treatment in community drug services while maintaining high sustained viral response rates and, in the Tayside region of Scotland, has led to a substantial reduction in chronic HCV in the population.
背景和目的：几乎没有实证证据表明，在人群层面上，为注射吸毒者（PWID）扩大直接作用抗病毒（DAA）治疗的规模会对丙型肝炎病毒（HCV）病毒血症产生“真实世界”的影响。我们旨在评估通过社区服务（包括药物治疗、药房、针具交换和监狱）为泰赛德地区的 PWID 迅速扩大 DAA 治疗规模的人群影响，与大格拉斯哥和克莱德（GGC）和苏格兰其他地区（RoS）相比。 设计、设置和参与者：自然实验，使用来自全国两年一次的 PWID 调查和全国临床数据的数据进行评估。苏格兰各地提供注射设备（2010-18 年）和 HCV 治疗诊所（2017-18 年）的服务。共有 12492 名完成问卷调查并提供血斑（检测 HCV 抗体和 RNA）的 PWID；4105 人开始接受 HCV 治疗。 干预和对照，测量：干预措施是泰赛德地区 PWID 中迅速扩大 DAA 的规模。对照组是 GGC/RoS。随着时间的推移，HCV 病毒血症的趋势和 HCV 治疗的采用率；按地区和治疗环境划分的治疗后持续病毒学应答（SVR）率。 发现：2013-14 年至 2017-18 年间，PWID 接受 HCV 治疗（去年）的比例从泰赛德的 15%增加到 43%，从 GGC 的 6%增加到 16%，从 RoS 的 11%增加到 23%。2010 年至 2017-18 年间，HCV 病毒血症（抗体阳性者）的流行率从泰赛德的 73%下降到 44%，从 GGC 的 67%下降到 58%，从 RoS 的 64%下降到 55%。与苏格兰其他地区（2017-18 年调整后的优势比[aOR]为 0.89，95%置信区间[CI]为 0.74-1.07，P=0.220）相比，泰赛德的病毒血症下降幅度更大（2017-18 年 aOR 为 0.47，95%CI 为 0.30-0.75，P=0.001），而 RoS（包括 GGC）的基线为 2013-14 年。在泰赛德，社区站点治疗的 PWID 的按方案 SVR 率与医院站点治疗的 PWID 没有差异（97.4%与 100.0%，P=0.099）。 结论：通过 HCV 检测和社区毒品服务中的治疗，可以在注射吸毒者中扩大直接作用抗病毒治疗的规模，同时保持高持续病毒学应答率，在苏格兰泰赛德地区，已经导致人群中慢性 HCV 的大量减少。
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