Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Department of Psychology, Clemson University, Clemson, SC 29634, USA.
Viruses. 2024 Aug 16;16(8):1304. doi: 10.3390/v16081304.
This study is a secondary analysis of a randomized clinical trial (October 2013-April 2017) involving 150 People Who Inject Drugs (PWIDs) with hepatitis (HCV) seen in opioid agonist treatment programs in the Bronx, New York, and investigates the impact of distrust in the healthcare system on adherence to Direct-Acting Antivirals (DAAs) HCV treatment therapy among PWIDs. The distrust was scaled on a 9-item instrument and the adherence to DAA medications was measured using electronic blister packs. This study demonstrated a significant inverse relationship between levels of distrust and medication adherence: 71.8 ± 2.2% (se) vs. 77.9 ± 1.8%, = 0.024 between participants with higher and lower distrust levels. Despite the absence of significant association of distrust with sociodemographic or substance use characteristics, these findings suggest that building trust within the healthcare system is paramount for improving adherence to DAAs among PWIDs. The results call for a healthcare approach that emphasizes trust-building through patient-centered care, sensitivity training, peer support, and health system reform to effectively address the treatment needs of this marginalized population.
本研究是对一项随机临床试验（2013 年 10 月至 2017 年 4 月）的二次分析，该试验涉及在纽约布朗克斯的阿片类药物激动剂治疗项目中接受治疗的 150 名注射毒品者（PWIDs），研究了对医疗保健系统的不信任对 PWIDs 接受直接作用抗病毒药物（DAAs）治疗 HCV 的依从性的影响。该不信任感通过 9 项量表进行评估，DAAs 药物的依从性通过电子泡罩包装进行测量。本研究表明，不信任感水平与药物依从性之间存在显著的负相关关系：71.8±2.2%（标准误）与 77.9±1.8%，=0.024，在高不信任感水平和低不信任感水平的参与者之间。尽管不信任与社会人口统计学或物质使用特征之间没有显著关联，但这些发现表明，在医疗保健系统中建立信任对于提高 PWIDs 对 DAAs 的依从性至关重要。研究结果呼吁采取一种医疗保健方法，强调通过以患者为中心的护理、敏感性培训、同伴支持和医疗体系改革来建立信任，以有效地满足这一边缘化人群的治疗需求。
