Liver Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
Addiction Department, AS Matera, Matera, Italy.
United European Gastroenterol J. 2021 Dec;9(10):1109-1118. doi: 10.1002/ueg2.12156. Epub 2021 Oct 26.
Rates of Hepatitis C virus (HCV) testing and diagnosis are variable among people who use drugs (PWUD). In Puglia in 2018, of 871 subjects screened, 38% had HCV antibodies (HCVAb). Despite sustained virologic response at week 12 Sustained virologic response (SVR12) rates >95%, addiction centers in Italy are not allowed to prescribe direct-acting antivirals (DAA).
To increase testing and linkage to care a dedicated program including "ad hoc" transportation and fast-track access to care was offered to PWUD from Puglia.
Over 12 months, 1,470 individuals seen at 15 Services for Dependence (SERDs) underwent screening. For HCVAb positive, a fast-track evaluation was offered at our Hepatology Unit. Patients were subsequently taken to their pharmacists to receive the prescribed DAA regimen. Treatment and adherence were supervised by SERDs physicians, SVR12 assessed at our unit. The scalability of the process was based on both, number of patients screened in our region in 2018, and number of PWUD diagnosed and treated at our center during 2018-2019.
Of 1,470 individuals screened, 634 (43.1%) tested HCVAb positive. Overall, 231 were RNA positive, 54% of whom on opioid agonist therapy (OAT) and 32% with cirrhosis. Median interval between RNA assessment and treatment start was 22 days (0-300). Patients received 12-week sofosbuvir/velpatasvir regimen without Ribavirin; in 220 patients who completed treatment, SVR12 was 98.6%. Among GT3, SVR12 was 98%. No re-infection was observed. Improvements in screening, and linkage to care were registered.
A PWUD-tailored service led to HCV care cascade improvement and high SVR12 rates. Despite history of drug addiction, social instability and logistic barriers, micro-elimination programs providing dedicated care are key drivers of success.
在吸毒人群（PWUD）中，丙型肝炎病毒（HCV）检测和诊断的比例各不相同。2018 年在普利亚，871 名筛查对象中有 38%的人 HCV 抗体（HCVAb）呈阳性。尽管在第 12 周时持续病毒学应答（SVR12）率>95%，意大利的成瘾中心仍被禁止开具直接作用抗病毒药物（DAA）。
为提高检测率并使吸毒者能够获得治疗，普利亚为吸毒者提供了一个专门的项目，包括“特别”交通和快速获得治疗的机会。
在 12 个月内，15 个依赖服务（SERD）机构的 1470 名个体接受了筛查。对于 HCVAb 阳性者，在我院肝病科进行快速评估。随后，患者被带到药剂师处接受处方 DAA 治疗方案。SERD 医生负责治疗和随访，在我院单位评估 SVR12。该流程的可扩展性基于 2018 年本地区筛查的患者人数，以及 2018-2019 年在我院诊断和治疗的吸毒者人数。
在 1470 名接受筛查的个体中，有 634 名（43.1%） HCVAb 检测呈阳性。总体而言，有 231 名 RNA 阳性，其中 54%正在接受阿片类药物激动剂治疗（OAT），32%患有肝硬化。从 RNA 评估到治疗开始的中位时间间隔为 22 天（0-300 天）。患者接受了 12 周的索非布韦/维帕他韦治疗方案，未使用利巴韦林；在 220 名完成治疗的患者中，SVR12 为 98.6%。在 GT3 中，SVR12 为 98%。未观察到再感染。登记了筛查和获得治疗的改善情况。
针对吸毒者的服务导致 HCV 护理级联的改善和高 SVR12 率。尽管存在吸毒史、社会不稳定和后勤障碍，但提供专门护理的微型消除项目是成功的关键驱动因素。
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