The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Int J Drug Policy. 2023 Jan;111:103917. doi: 10.1016/j.drugpo.2022.103917. Epub 2022 Dec 19.
With the advent of direct acting antiviral (DAA) therapies for the treatment of hepatitis C virus (HCV), the World Health Organization recommended a goal to eliminate HCV as a public health threat globally by 2030. With the majority of new and existing infections in high income countries occurring among people who inject drugs, achieving this goal will require the design and implementation of interventions which address the unique barriers to HCV care faced by this population.
In this systematic review and meta-analysis, we searched bibliographic databases and conference abstracts to July 21, 2020 for studies assessing interventions to improve the following study outcomes: HCV antibody testing, HCV RNA testing, linkage to care, and treatment initiation. We included both randomised and non-randomised studies which included a comparator arm. We excluded studies which enrolled only paediatric populations (<18 years old) and studies where the intervention was conducted in a different healthcare setting than the control or comparator. This analysis was restricted to studies conducted among people who inject drugs. Data were extracted from the identified records and meta-analysis was used to pool the effect of interventions on study outcomes. This study was registered in PROSPERO (CRD42020178035).
Of 15,342 unique records, 45 studies described the implementation of an intervention to improve HCV testing, linkage to care and treatment initiation among people who inject drugs. These included 27 randomised trials and 18 non-randomised studies with the risk of bias rated as "critical" for most non-randomised studies. Patient education and patient navigation to address patient-level barriers to HCV care were shown to improve antibody testing uptake and linkage to HCV care respectively although patient education did not improve antibody testing when restricted to randomised studies. Provider care coordination to address provider level barriers to HCV care was effective at improving antibody testing uptake. Three different interventions to address systems-level barriers to HCV care were effective across different stages of HCV care: point-of-care antibody testing (linkage to care); dried blood-spot testing (antibody testing uptake); and integrated care (linkage to care and treatment initiation).
Multiple interventions are available that can address the barriers to HCV care for people who inject drugs at the patient-, provider-, and systems-level. The design of models of care to improve HCV testing and treatment among people who inject drugs must consider the unique barriers to care that this population faces. Further research, including high-quality randomised controlled trials, are needed to robustly assess the impact these interventions can have in varied populations and settings.
随着直接作用抗病毒（DAA）疗法治疗丙型肝炎病毒（HCV）的出现，世界卫生组织建议到 2030 年在全球消除 HCV 对公共健康的威胁。在高收入国家，大多数新的和现有的感染发生在注射毒品的人群中，要实现这一目标，就需要设计和实施干预措施，以解决这一人群面临的独特的 HCV 护理障碍。
在这项系统评价和荟萃分析中，我们检索了文献数据库和会议摘要，以获取 2020 年 7 月 21 日之前评估改善以下研究结果的干预措施的研究：抗 HCV 抗体检测、HCV RNA 检测、与护理的衔接以及治疗启动。我们纳入了包括对照臂的随机和非随机研究。我们排除了仅招募儿科人群（<18 岁）的研究，以及干预措施在与对照或比较组不同的医疗保健环境中进行的研究。这项分析仅限于在注射毒品者中进行的研究。从确定的记录中提取数据，并使用荟萃分析来汇总干预措施对研究结果的影响。本研究已在 PROSPERO（CRD42020178035）中注册。
在 15342 个独特的记录中，有 45 项研究描述了在注射毒品者中实施干预措施以改善 HCV 检测、与 HCV 护理的衔接和治疗启动。这些研究包括 27 项随机试验和 18 项非随机研究，大多数非随机研究的偏倚风险被评为“关键”。针对 HCV 护理患者水平障碍的患者教育和患者导航分别显示可提高抗体检测率和与 HCV 护理的衔接，但在仅限于随机研究时，患者教育并未提高抗体检测率。针对 HCV 护理提供者水平障碍的提供者护理协调可有效提高抗体检测率。针对 HCV 护理系统水平障碍的三种不同干预措施在 HCV 护理的不同阶段都有效：即时抗体检测（与护理的衔接）；干血斑检测（抗体检测率）；以及综合护理（与护理和治疗启动的衔接）。
有多种干预措施可用于解决注射毒品者 HCV 护理的患者、提供者和系统层面的障碍。设计改善注射毒品者 HCV 检测和治疗的护理模式必须考虑到该人群面临的独特的护理障碍。需要进一步的研究，包括高质量的随机对照试验，以可靠地评估这些干预措施在不同人群和环境中的影响。
