University of Toronto, Department of Medicine, Toronto, Canada.
City University of New York Graduate School of Public Health and Health Policy, New York, New York, United States of America.
PLoS One. 2024 Aug 29;19(8):e0308102. doi: 10.1371/journal.pone.0308102. eCollection 2024.
The main mode of transmission of Hepatitis C in North America is through injection drug use. Availability of accessible care for people who inject drugs is crucial for achieving hepatitis C elimination.
The objective of this analysis is to compare the changes in injection drug use frequency and high-risk injection behaviors in participants who were randomized to accessible hepatitis c care versus usual hepatitis c care.
Participants who were hepatitis C virus RNA positive and had injected drugs in the last 90 days were enrolled and randomized 1:1 to an on-site, low threshold accessible care arm or a standard, referral-based usual care arm. Participants attended follow-up appointments at 3, 6, 9, and 12 months during which they answered questions regarding injection drug use frequency, behaviors, and treatment for opioid use disorder.
The primary outcomes of this secondary analysis are the changes in the frequency of injection drug use, high-risk injection behaviors, and receiving medication for opioid use disorder in the last 30 days.
A total of 165 participants were enrolled in the study, with 82 participants in the accessible care arm and 83 participants in the usual care arm. Participants in the accessible care arm were found to have a statistically significant higher likelihood of reporting a lower range of injection days (accessible care-by-time effect OR = 0.78, 95% CI = 0.62-0.98) and injection events (accessible care-by-time effect OR = 0.70, 95% CI = 0.56-0.88) in the last 30 days at a follow-up interview relative to those in the usual care arm. There were no statistically significant differences in the rates of decrease in receptive sharing of injection equipment or in the percentage of participants receiving treatment for opioid use disorders in the two arms.
Hepatitis C treatment through an accessible care model resulted in statistically higher rates of decrease in injection drug use frequency in people who inject drugs.
在北美，丙型肝炎的主要传播途径是注射吸毒。为了实现丙型肝炎的消除，为注射吸毒者提供可及的护理至关重要。
本分析的目的是比较随机分配到可及性丙型肝炎护理组与常规丙型肝炎护理组的参与者中，注射毒品频率和高危注射行为的变化。
招募丙型肝炎病毒 RNA 阳性且在过去 90 天内注射过毒品的参与者，并将其 1:1 随机分配到现场、低门槛可及性护理组或标准、基于转诊的常规护理组。参与者在 3、6、9 和 12 个月时进行随访预约，在此期间，他们回答了关于注射毒品使用频率、行为和阿片类药物使用障碍治疗的问题。
本次二次分析的主要结局是在过去 30 天内，注射毒品使用频率、高危注射行为和接受阿片类药物使用障碍治疗的变化。
共有 165 名参与者入组研究，其中可及性护理组 82 名，常规护理组 83 名。与常规护理组相比，可及性护理组参与者在报告注射天数（可及性护理-时间效应 OR = 0.78，95%CI = 0.62-0.98）和注射事件（可及性护理-时间效应 OR = 0.70，95%CI = 0.56-0.88）的可能性显著更高，这些注射事件发生在过去 30 天的随访访谈中。在接受注射设备共享的接受性共享率或接受阿片类药物使用障碍治疗的参与者百分比方面，两组之间没有统计学显著差异。
通过可及性护理模式进行丙型肝炎治疗可显著降低注射吸毒者的注射毒品使用频率。
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