Boke Joyce, Monroe-Wise Aliza, Umutesi Grace, Mbogo Loice, Sambai Betsy, Bukusi David, Chohan Bhavna, Scott John, Gitau Esther, Sinkele William, Musyoki Helgar, Herbeck Joshua, Farquhar Carey, Guthrie Brandon L
Global Assistance Program-Kenya, University of Washington, Nairobi, Kenya.
Department of Global Health, University of Washington, Seattle, WA, United States.
Front Med (Lausanne). 2024 Oct 21;11:1429516. doi: 10.3389/fmed.2024.1429516. eCollection 2024.
Despite having a higher risk of hepatitis C virus (HCV) infections, people who inject drugs (PWID) in sub-Saharan Africa (SSA) have limited access to HCV treatment. There is scarce literature on treatment delivery modalities that overcome logistical and financial barriers. We utilized different service delivery modalities to provide direct-acting antivirals (DAAs) to PWIDs infected with HCV through methadone clinics and needle and syringe program (NSP) sites in Kenya. In collaboration with Kenya's National AIDS and STI Control Programme (NASCOP), we enrolled individuals with active HCV infection confirmed by HCV RNA detection from methadone and NSP sites in Nairobi, Mombasa, and Kilifi counties. Liver function and hepatitis B virus (HBV) status were assessed at baseline. Those eligible for treatment were offered ledipasvir-sofosbuvir treatment provided by NASCOP through directly observed therapy (DOT). Participants completed a follow-up visit 12 weeks after completing treatment to measure sustained viral response (SVR-12). Challenges faced while delivering HCV treatment at participating sites included the limited availability and reliability of laboratory assays, and financial constraints faced by PWIDs to attend daily DOT. Based on our experience, strategies to deliver HCV treatment for PWID in Kenya should consider improving the availability of laboratory tests and prioritizing treatment through methadone centers to achieve good outcomes.
尽管撒哈拉以南非洲地区（SSA）注射毒品者（PWID）感染丙型肝炎病毒（HCV）的风险较高，但他们获得HCV治疗的机会有限。关于克服后勤和资金障碍的治疗提供方式的文献很少。我们利用不同的服务提供方式，通过肯尼亚的美沙酮诊所和针头与注射器项目（NSP）站点，为感染HCV的PWID提供直接抗病毒药物（DAA）。我们与肯尼亚国家艾滋病和性传播感染控制项目（NASCOP）合作，从内罗毕、蒙巴萨和基利菲县的美沙酮和NSP站点招募经HCV RNA检测确诊为活动性HCV感染的个体。在基线时评估肝功能和乙型肝炎病毒（HBV）状态。符合治疗条件的患者接受NASCOP通过直接观察治疗（DOT）提供的来迪派韦-索磷布韦治疗。参与者在完成治疗12周后进行随访，以测量持续病毒学应答（SVR-12）。在参与治疗的站点提供HCV治疗时面临的挑战包括实验室检测的可用性和可靠性有限，以及PWID在接受每日DOT治疗时面临的资金限制。根据我们的经验，肯尼亚为PWID提供HCV治疗的策略应考虑提高实验室检测的可用性，并优先通过美沙酮中心进行治疗，以取得良好效果。
