St Vincent's Hospital Melbourne, Melbourne, VIC.
The University of Melbourne, Melbourne, VIC.
Med J Aust. 2023 Apr 3;218(6):256-261. doi: 10.5694/mja2.51885. Epub 2023 Mar 14.
To evaluate the feasibility of testing and treating people who inject drugs at a supervised injecting facility for hepatitis C virus (HCV) infection.
Retrospective cohort study.
SETTING, PARTICIPANTS: People who inject drugs who attended the Melbourne supervised injecting facility, 30 June 2018 - 30 June 2020.
Proportion of people tested for hepatitis C; proportions of people positive for anti-HCV antibody and HCV RNA, and of eligible people prescribed direct-acting antiviral (DAA) treatment; sustained virological response twelve weeks or more after treatment completion.
Of 4649 people who attended the supervised injecting facility during 2018-20, 321 were tested for hepatitis C (7%); 279 were anti-HCV antibody-positive (87%), of whom 143 (51%) were also HCV RNA-positive. Sixty-four of 321 had previously been treated for hepatitis C (20%), 21 had clinically identified cirrhosis (7%), eight had hepatitis B infections (2%), and four had human immunodeficiency virus infections (1%). In multivariate analyses, people tested for hepatitis C were more likely than untested clients to report psychiatric illness (adjusted odds ratio [aOR], 9.65; 95% confidence interval [CI], 7.26-12.8), not have a fixed address (aOR, 1.59; 95% CI, 1.18-2.14), and to report significant alcohol use (aOR, 1.57; 95% CI, 1.06-2.32). The median number of injecting facility visits was larger for those tested for hepatitis C (101; interquartile range [IQR], 31-236) than for those not tested (20; IQR, 3-90). DAA treatment was prescribed for 126 of 143 HCV RNA-positive clients (88%); 41 of 54 with complete follow-up data were cured (76%).
People who attend supervised injecting facilities can be tested and treated for hepatitis C on site. Models that provide streamlined, convenient hepatitis C care promote engagement with treatment in a group in which the prevalence of hepatitis C is high.
评估在监督注射场所对吸毒者进行丙型肝炎病毒（HCV）感染检测和治疗的可行性。
回顾性队列研究。
地点、参与者：2018 年 6 月 30 日至 2020 年 6 月 30 日期间在墨尔本监督注射场所注射毒品的吸毒者。
接受 HCV 检测的人数比例；抗-HCV 抗体和 HCV RNA 阳性的人数比例，以及符合条件的人接受直接作用抗病毒（DAA）治疗的比例；治疗完成后 12 周或更长时间的持续病毒学应答。
在 2018 年至 2020 年期间，有 4649 人在监督注射场所就诊，其中 321 人接受了 HCV 检测（7%）；279 人抗-HCV 抗体阳性（87%），其中 143 人（51%）HCV RNA 也阳性。321 人中，64 人（20%）既往接受过 HCV 治疗，21 人（7%）有临床确诊的肝硬化，8 人（2%）有乙型肝炎感染，4 人（1%）有人免疫缺陷病毒感染。在多变量分析中，接受 HCV 检测的人与未接受检测的患者相比，更有可能报告有精神疾病（调整后的优势比 [aOR]，9.65；95%置信区间 [CI]，7.26-12.8）、无固定住址（aOR，1.59；95%CI，1.18-2.14）和有显著的酒精使用（aOR，1.57；95%CI，1.06-2.32）。接受 HCV 检测的人的监督注射场所就诊次数中位数大于未接受检测的（101；四分位间距 [IQR]，31-236 比 20；IQR，3-90）。143 例 HCV RNA 阳性患者中，126 例（88%）开具了 DAA 治疗处方；54 例有完整随访数据的患者中，41 例（76%）治愈。
可以在监督注射场所对吸毒者进行现场 HCV 检测和治疗。提供简化、便捷的丙型肝炎治疗模式，促进了在丙型肝炎流行率较高的人群中接受治疗的机会。
