Klasa Per-Erik, Sandell Mikael, Aleman Soo, Kåberg Martin
Prima Maria OAT Clinic, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
BMC Psychiatry. 2025 Mar 27;25(1):291. doi: 10.1186/s12888-025-06733-3.
People with opioid agonist therapy (OAT) represent a population with an increased hepatitis C (HCV) prevalence. Recent studies provide strong evidence regarding effective HCV treatment outcomes and low levels of reinfection in this population. Increased access to HCV care for people with OAT is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030.
The Maria OAT clinic, located in central Stockholm, provides OAT for approximately 500 patients. The majority have a history of injection drug use. In October 2017, psychiatrist-led HCV treatment was initiated, with remote consultation support from the local infectious diseases clinic. All OAT staff participated in HCV-specific education to increase HCV awareness. To evaluate HCV treatment outcomes for this model of care, we examined sustained virological response (SVR) and reinfection rates between January 2018 and December 2022.
Between October 2017 and June 2022, 133 participants received HCV treatment through weekly administrations or directly observed treatment. 72% were men, and the overall mean age was 44.7 years. Six participants were retreated, giving a total of 139 treatment initiations. All were HCV RNA negative at end of treatment, and 88% reached SVR. A total of 11 reinfections post SVR were noted, with a reinfection rate of 7.3/100 person-years (95% CI 4.1-12.9).
Overall, successful HCV treatment results and levels of reinfections consistent with the literature were achieved. Bringing HCV diagnostics and treatment to an OAT clinic constitutes a good example of enhancing the HCV continuum of care. Furthermore, HCV treatment education for psychiatrists, addiction specialists and staff at OAT clinics makes HCV care more sustainable, as specifically noted during the COVID-19 pandemic. This successful model of care, introducing HCV treatment by psychiatrists on-site at OAT clinics, has now been further implemented at other OAT clinics in Stockholm.
接受阿片类激动剂治疗（OAT）的人群丙型肝炎（HCV）患病率较高。近期研究为该人群HCV治疗的有效结果及低再感染率提供了有力证据。增加OAT人群获得HCV治疗的机会对于实现世界卫生组织到2030年消除HCV作为主要公共卫生威胁的目标至关重要。
位于斯德哥尔摩市中心的玛丽亚OAT诊所为约500名患者提供OAT。大多数患者有注射吸毒史。2017年10月，在当地传染病诊所的远程会诊支持下，由精神科医生主导启动了HCV治疗。所有OAT工作人员都参加了针对HCV的教育，以提高对HCV的认识。为评估这种护理模式的HCV治疗结果，我们检查了2018年1月至2022年12月期间的持续病毒学应答（SVR）和再感染率。
2017年10月至2022年6月期间，133名参与者通过每周给药或直接观察治疗接受了HCV治疗。72%为男性，总体平均年龄为44.7岁。6名参与者接受了再次治疗，共开始了139次治疗。所有患者在治疗结束时HCV RNA均为阴性，88%达到SVR。共记录到11例SVR后的再感染，再感染率为7.3/100人年（95%CI 4.1-12.9）。
总体而言，取得了与文献一致的成功HCV治疗结果和再感染水平。将HCV诊断和治疗引入OAT诊所是加强HCV连续护理的一个良好范例。此外，对精神科医生、成瘾专家和OAT诊所工作人员进行HCV治疗教育使HCV护理更具可持续性，在2019冠状病毒病大流行期间尤其如此。这种成功的护理模式，即由精神科医生在OAT诊所现场开展HCV治疗，现已在斯德哥尔摩的其他OAT诊所进一步实施。
