在丙型肝炎病毒感染者中使用直接作用抗病毒药物：一项定性研究。
Accessing hepatitis C direct acting antivirals among people living with hepatitis C: a qualitative study.
机构信息
Li Ka Shing Knowledge Institute, Unity Health, Toronto, ON, Canada.
Department of Family and Community Medicine, Unity Health, Toronto, ON, Canada.
出版信息
Int J Equity Health. 2023 Jun 6;22(1):112. doi: 10.1186/s12939-023-01924-4.
BACKGROUND
Hepatitis C is curable with direct-acting antivirals (DAAs). However, treatment uptake remains low among marginalized populations such as people who inject drugs. We sought to understand challenges to treatment uptake with DAAs among people living with hepatitis C and compare treatment experiences between people who do and do not inject prescription and/or unregulated drugs.
METHODS
We conducted a qualitative study using focus groups with 23 adults aged 18 years and over who completed DAA treatment or were about to begin such treatment at the time of the study. Participants were recruited from hepatitis C treatment clinics across Toronto, Ontario. We drew upon stigma theory to interpret participants' accounts.
RESULTS
Following analysis and interpretation, we generated five theoretically-informed themes characterizing the experiences of individuals accessing DAAs: "being 'worthy' of the cure", "spatially enacted stigma", "countering social and structural vulnerability: the importance of peers", "identity disruption and contagion: attaining a 'social cure'" and "challenging stigma with population-based screening". Overall, our findings suggest that structural stigma generated and reproduced through healthcare encounters limits access to DAAs among people who inject drugs. Peer-based programs and population-based screening were proposed by participants as mechanisms for countering stigma within health care settings and 'normalizing' hepatitis C among the general population.
CONCLUSIONS
Despite the availability of curative therapies, access to such treatment for people who inject drugs is limited by stigma enacted in and structured within healthcare encounters. Developing novel, low-threshold delivery programs that remove power differentials and attend to the social and structural determinants of health and reinfection are needed to facilitate further scale up of DAAs and support the goal of eradicating hepatitis C as a public health threat.
背景
丙型肝炎可通过直接作用抗病毒药物（DAAs）治愈。然而，在边缘化人群（如注射毒品者）中，接受 DAA 治疗的比例仍然较低。我们试图了解丙型肝炎患者接受 DAA 治疗的障碍，并比较注射处方和/或不受管制药物者与不注射者的治疗经历。
方法
我们采用焦点小组方法，对 23 名年龄在 18 岁及以上的成年人进行了定性研究，这些参与者在研究时已经完成 DAA 治疗或即将开始这种治疗。参与者是从安大略省多伦多的丙型肝炎治疗诊所招募的。我们借鉴污名化理论来解释参与者的叙述。
结果
经过分析和解释，我们生成了五个理论上有启发性的主题，这些主题描绘了个体获得 DAA 的经历：“值得治愈”、“空间上表现出的污名”、“克服社会和结构性脆弱性：同伴的重要性”、“身份破坏和传染：获得‘社会治愈’”和“通过人群筛查挑战污名”。总体而言，我们的研究结果表明，在医疗保健环境中产生和再现的结构性污名将限制注射毒品者获得 DAA 的机会。基于同伴的项目和人群筛查被参与者提出，作为在医疗保健环境中对抗污名的机制，并在普通人群中“使丙型肝炎正常化”。
结论
尽管有治愈疗法，但由于在医疗保健接触中实施和结构化的污名，注射毒品者获得这种治疗的机会受到限制。需要开发新的、低门槛的交付方案，以消除权力差距，并关注健康的社会和结构性决定因素以及再感染，以促进 DAA 的进一步扩大，并支持消除丙型肝炎作为公共卫生威胁的目标。
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