Coupland Heidi, Day Carolyn, Haber Paul, Pritchard-Jones Janice, McKee Kristen, George Jacob, McCaughan Geoff
Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, Australia.
Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia.
Drug Alcohol Rev. 2022 Mar;41(3):706-714. doi: 10.1111/dar.13414. Epub 2021 Nov 28.
Opioid agonist treatment (OAT) clinics play a key role in achieving elimination of hepatitis C virus (HCV) globally. Previous research has identified barriers to HCV treatment uptake in OAT clinics; however, most studies were conducted prior to the introduction of direct-acting antiviral treatments (DAA). It remains unclear whether progress has been made in responding to barriers and what challenges persist in this setting.
Semi-structured in-depth interviews were conducted with staff (n = 20) and clients (n = 15) in two OAT clinics in Sydney, Australia. Interviews were transcribed verbatim and analysed using constant comparative methods.
Despite progress in integrating hepatitis C care in the clinics, competing priorities, concerns about side-effects, distrust of staff, health problems and difficulties accessing testing and medication persisted as key reasons why clients had not initiated treatment. Most clients preferred to postpone treatment and focus on other priorities and some highlighted lack of medical evidence for urgent treatment. Pressure on services to achieve elimination targets within set time frames was a primary driver of repeated offers of treatment by staff and the framing of clients' preferences for postponing treatment, as a barrier.
Current timelines for HCV elimination targets may have galvanised services into action but may have also created tensions at the coalface due to disparities between staff and clients' priorities. The involvement of peer workers and mechanisms to ensure continued follow up with clients about DAA treatments is required. Public health timelines for HCV elimination need to be informed by affected communities' priorities.
阿片类激动剂治疗（OAT）诊所对于在全球范围内实现丙型肝炎病毒（HCV）消除起着关键作用。先前的研究已确定了OAT诊所中丙型肝炎治疗接受方面的障碍；然而，大多数研究是在直接作用抗病毒治疗（DAA）引入之前进行的。目前尚不清楚在应对这些障碍方面是否取得了进展，以及在这种情况下仍存在哪些挑战。
对澳大利亚悉尼的两家OAT诊所的工作人员（n = 20）和客户（n = 15）进行了半结构化深度访谈。访谈内容逐字转录，并采用持续比较法进行分析。
尽管诊所在整合丙型肝炎护理方面取得了进展，但相互竞争的优先事项、对副作用的担忧、对工作人员的不信任、健康问题以及获取检测和药物的困难，仍然是客户未开始治疗的主要原因。大多数客户倾向于推迟治疗，专注于其他优先事项，一些人强调缺乏紧急治疗的医学证据。在规定时间框架内实现消除目标的服务压力，是工作人员反复提供治疗以及将客户推迟治疗的偏好视为障碍的主要驱动因素。
当前丙型肝炎消除目标的时间线可能促使服务机构采取行动，但由于工作人员和客户优先事项之间的差异，也可能在实际工作中造成紧张关系。需要同伴工作者的参与以及确保对客户进行持续随访以了解DAA治疗情况的机制。丙型肝炎消除的公共卫生时间线需要以受影响社区的优先事项为依据。
