Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.
Harm Reduction Unit 'SMASD', Addictions and Mental Health Department, Madrid, Spain.
Liver Int. 2022 Feb;42(2):309-319. doi: 10.1111/liv.15095. Epub 2021 Nov 17.
People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analysed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point-of-care (PoC).
From 2019 to 2021, a mobile unit was used to screen active HCV using a linkage-to-care and two-step PoC-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals and people with a mental health disorder (MHD) and alcohol use disorder (AUD). Logistic regression, and Cox and Aalen's additive models were used to analyse associated factors and differences between groups.
A prospectively recruited cohort of 214 HCV-infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved sustained virological response (SVR). PWID were significantly less likely to initiate treatment, whereas individuals with AUD waited longer before starting the treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment.
Overall, SVR was achieved in the majority of the participants treated. However, PWID need better linkage to care and treatment, whereas PWID and AUD need more support for treatment completion.
由于健康、行政和社会障碍，注射毒品者（PWID）和其他感染率较高的边缘化人群在开始治疗方面代表了一个独特的挑战。我们分析了西班牙马德里一些弱势亚人群的丙型肝炎病毒（HCV）治疗流程（CoC），使用了移动即时护理（PoC）。
从 2019 年到 2021 年，使用移动单位使用链接至护理和两步基于 PoC 的策略来筛查活跃的 HCV。病毒血症参与者被分为四组：PWID、无家可归者以及患有精神健康障碍（MHD）和酒精使用障碍（AUD）的人。使用逻辑回归、Cox 和 Aalen 的加法模型分析相关因素和组间差异。
前瞻性招募了 214 名 HCV 感染个体（73 名 PWID、141 名无家可归者、57 名 MHD 和 91 名 AUD）参加了该研究。整体 HCV CoC 分析发现，178 人（83.1%）就诊于医院，164 人（76.6%）开始直接作用抗病毒治疗，141 人（65.8%）完成治疗，其中 141 人（95.2%）实现持续病毒学应答（SVR）。PWID 开始治疗的可能性显著较低，而 AUD 患者开始治疗前等待的时间更长。AUD 患者和 PWID 患者完成 HCV 治疗的可能性明显较低。
总体而言，接受治疗的大多数参与者都实现了 SVR。然而，PWID 需要更好的治疗衔接，而 PWID 和 AUD 需要更多的治疗完成支持。
