Clinical Research Center, Sultanah Bahiyah Hospital, 05460, Alor Setar, Kedah, Malaysia.
Public Health Division, State Health Department, Kuala Terengganu, Terengganu, Malaysia.
Harm Reduct J. 2023 Apr 12;20(1):48. doi: 10.1186/s12954-023-00780-3.
Despite advancements in hepatitis C virus (HCV) treatment, low uptake among hard-to-reach populations remains a global issue. The current study aimed to assess the feasibility of a modified same-day test-and-treat model in improving HCV care for people who inject drugs (PWID) living in resource-constrained rural areas.
A pilot study was conducted in four primary healthcare (PHC) centers in Malaysia. The model's key features included on-site HCV ribonucleic acid (RNA) testing using a shared GeneXpert® system; noninvasive biomarkers for cirrhosis diagnosis; and extended care to PWID referred from nearby PHC centers and outreach programs. The feasibility assessment focused on three aspects of the model: demand (i.e., uptake of HCV RNA testing and treatment), implementation (i.e., achievement of each step in the HCV care cascade), and practicality (i.e., ability to identify PWID with HCV and expedite treatment initiation despite resource constraints).
A total of 199 anti-HCV-positive PWID were recruited. They demonstrated high demand for HCV care, with a 100% uptake of HCV RNA testing and 97.4% uptake of direct-acting antiviral treatment. The rates of HCV RNA positivity (78.4%) and sustained virologic response (92.2%) were comparable to standard practice, indicating the successful implementation of the model. The model was also practical, as it covered non-opioid-substitution-therapy-receiving individuals and enabled same-day treatment in 71.1% of the participants.
The modified same-day test-and-treat model is feasible in improving HCV care for rural PWID. The study finding suggests its potential for wider adoption in HCV care for hard-to-reach populations.
尽管丙型肝炎病毒 (HCV) 治疗取得了进展，但在难以接触到的人群中，接受治疗的比例仍然很低，这是一个全球性问题。本研究旨在评估改良的当日检测和治疗模式在改善资源有限的农村地区注射吸毒者 (PWID) 的 HCV 护理方面的可行性。
在马来西亚的四个基层医疗 (PHC) 中心进行了一项试点研究。该模型的主要特点包括使用共享 GeneXpert®系统进行现场 HCV 核糖核酸 (RNA) 检测；用于肝硬化诊断的非侵入性生物标志物；以及向附近 PHC 中心和外展计划转介的 PWID 提供扩展护理。可行性评估侧重于该模型的三个方面：需求（即 HCV RNA 检测和治疗的接受程度）、实施（即 HCV 护理级联中的每一步的实现）和实用性（即，尽管资源有限，仍有能力识别 HCV 阳性的 PWID 并加快治疗启动）。
共招募了 199 名抗 HCV 阳性的 PWID。他们对 HCV 护理的需求很高，HCV RNA 检测的接受率为 100%，直接作用抗病毒治疗的接受率为 97.4%。HCV RNA 阳性率（78.4%）和持续病毒学应答率（92.2%）与标准实践相当，表明该模型的成功实施。该模型也具有实用性，因为它涵盖了未接受阿片类药物替代疗法的个体，并使 71.1%的参与者能够在当天接受治疗。
改良的当日检测和治疗模式在改善农村地区 PWID 的 HCV 护理方面是可行的。研究结果表明，该模式在为难以接触到的人群提供 HCV 护理方面具有广泛应用的潜力。
