National Center for Disease Control and Public Health, Georgia.
Tbilisi State Medical University, Georgia.
Public Health. 2021 Jun;195:42-50. doi: 10.1016/j.puhe.2021.03.017. Epub 2021 May 27.
There is a dearth of research on hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWIDs) and receive methadone substitution treatment (MST) in Eastern Europe and Central Asia countries. This study contributed to addressing that gap. We examined and identified factors that may affect HCV treatment uptake among PWID who received MST in the Republic of Georgia.
The design of the study is retrospective cohort study.
We conducted HCV care cascade analysis by matching the data from the web-based national hepatitis C program registry (ELIM C) and the MST treatment database between January 1, 2015, and December 31, 2018. Using the World Health Organization's (WHO) Consensus HCV cascade of care (CoC) global instrument, we assessed the progress made toward the country's 2020 and WHO's 2030 hepatitis C elimination targets for the subpopulation of MST patients.
Overall, 10,498 individuals have been dispensed methadone during the study period. A total of 6828 MST beneficiaries had HCV screening, of whom 5843 (85.6%) tested positive; 5476 (93.7%) were tested for HCV viremia, and 5275 (96.3%) were confirmed with chronic HCV infection. More than 75% (n = 4000) of HCV-infected MST patients initiated HCV treatment, and 3772 (94.3%) completed the treatment. Of those eligible for sustained virologic response assessment, 71.0% (2641/3715) were evaluated, and the reported cure rate was 96.1% (2537). The study found the odds of patients starting HCV treatment differed by the type of facility they were screened at and whether they were registered as PWID at the screening sites. The patients screened at centers with integrated HCV treatment services had higher treatment uptake rates than those screened at other centers.
As the cumulative HCV treatment uptake and cure rates among MST patients with HCV infection are high (75.8% and 96.1%, respectively), the MST patients might become the first microelimination target population in which hepatitis C elimination will be achieved in Georgia. The study found the type of screening facility and whether MST patients registered themselves as PWID or not had significant effects on MST patients starting HCV treatment. At the same time, the study did not find gender and age to be significant predictors of MST patients starting HCV treatment. MST patients used different types of health facilities to get screened for HIV. Many of them did not register themselves as PWID when screened for HIV. The existence of only a few harm reduction sites with integrated HCV treatment services, a high level of stigma, and the criminalization of drug use might have incentivized MST patients to self-navigate across the HCV care continuum with the rest of the population. The implementation of focused, harm reduction, integrated HCV treatment with good peer and professional adherence support at treatment sites could help reach the hepatitis C elimination goals among MST patients.
东欧和中亚国家针对注射吸毒者（PWID）和接受美沙酮替代治疗（MST）人群的丙型肝炎病毒（HCV）治疗参与情况的研究相对较少。本研究旨在填补这一空白。我们研究并确定了影响格鲁吉亚接受 MST 的 PWID 接受 HCV 治疗的因素。
本研究为回顾性队列研究。
我们通过匹配 2015 年 1 月 1 日至 2018 年 12 月 31 日期间基于网络的国家丙型肝炎规划登记处（ELIM C）和 MST 治疗数据库的数据，进行 HCV 护理级联分析。我们使用世界卫生组织（WHO）的 HCV 护理级联全球共识工具（Consensus HCV Cascade of Care，CoC）评估 MST 患者亚群在该国 2020 年和 WHO 2030 年消除丙型肝炎目标方面取得的进展。
研究期间共有 10498 人接受美沙酮治疗。共有 6828 名 MST 受惠者接受了 HCV 筛查，其中 5843 人（85.6%）检测结果呈阳性；5476 人（93.7%）检测 HCV 病毒血症，5275 人（96.3%）确诊患有慢性 HCV 感染。超过 75%（n=4000）的 HCV 感染 MST 患者开始接受 HCV 治疗，3772 人（94.3%）完成了治疗。在有资格进行持续病毒学应答评估的患者中，71.0%（2641/3715）进行了评估，报告的治愈率为 96.1%（2537）。研究发现，患者开始 HCV 治疗的可能性因他们接受筛查的机构类型以及他们在筛查点是否登记为 PWID 而异。在提供综合 HCV 治疗服务的中心接受筛查的患者治疗率高于在其他中心接受筛查的患者。
由于 MST 患者中 HCV 治疗的累积参与率和治愈率均较高（分别为 75.8%和 96.1%），因此 MST 患者可能成为格鲁吉亚第一个实现丙型肝炎消除的微消除目标人群。研究发现，筛查机构的类型以及 MST 患者是否自行登记为 PWID 对 MST 患者开始 HCV 治疗有显著影响。同时，研究未发现性别和年龄对 MST 患者开始 HCV 治疗有显著影响。MST 患者使用不同类型的卫生设施进行 HIV 筛查。许多人在筛查 HIV 时并未自行登记为 PWID。由于只有少数几个提供综合 HCV 治疗服务的减少伤害场所，加之高水平的污名化和药物使用的刑事化，可能促使 MST 患者与其他人群一起自行跨越 HCV 护理连续体。在治疗点实施以重点关注、减少伤害为基础、提供综合 HCV 治疗，并辅以良好的同伴和专业人员支持，可能有助于 MST 患者实现消除丙型肝炎的目标。
