Assessment and Treatment of Hepatitis C Virus Infection Among People Who Inject Drugs in the Opioid Substitution Setting: ETHOS Study
Assessment and Treatment of Hepatitis C Virus Infection Among People Who Inject Drugs in the Opioid Substitution Setting: ETHOS Study
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DOI：
10.1093/cid/cit305
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发表时间：
2013-08-15
影响因子：
11.8
通讯作者：
Dore, Gregory J.
中科院分区：
文献类型：
--
作者：
Alavi, Maryam;Grebely, Jason;Dore, Gregory J.
背景在注射吸毒者中，获得丙型肝炎病毒（HCV）治疗的机会仍然非常有限。HCV评估和治疗通过一种创新的模式进行评估，为慢性HCV感染的PWID提供HCV护理。加强阿片类药物替代环境中的丙型肝炎治疗（ETHOS）是一项前瞻性观察队列研究。招募是通过5阿片类药物替代治疗（OST）诊所，2个社区卫生中心，和1个土著社区控制的卫生组织在澳大利亚新南威尔士州。在387名参与者中，平均年龄为41岁，71%为男性，15%为土著民族。对191名（49%）参与者进行了专家评估，84名（22%）开始了基于干扰素的治疗。在校正分析中，HCV专家评估与非原住民种族（校正比值比[AOR]，4.02; 95%置信区间[CI]，2.05-7.90）、近期未使用苯二氮卓类药物（AOR，2.06; 95% CI，1.31-3.24）和非1 HCV基因型（AOR，2.13; 95% CI，1.32-3.43）相关。在校正分析中，HCV治疗与非土著种族相关，（AOR，4.59; 95% CI，1.49-14.12），在家人和/或朋友的支持下生活（AOR，2.15; 95% CI，1.25-3.71），从未接受过OST（AOR，4.40; 95% CI，2.27-8.54），近期未使用甲基苯丙胺（AOR，2.26; 95% CI，1.12-4.57），和非1 HCV基因型（AOR，3.07; 95% CI，1.67-5.64）。在这一高度边缘化的PWID人群中，HCV治疗摄取率相对较高。与治疗相关的潜在可变因素包括药物使用和社会支持。
Background. Access to hepatitis C virus (HCV) treatment remains extremely limited among people who inject drugs (PWID). HCV assessment and treatment was evaluated through an innovative model for the provision of HCV care among PWID with chronic HCV infection.Methods. Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) was a prospective observational cohort. Recruitment was through 5 opioid substitution treatment (OST) clinics, 2 community health centers, and 1 Aboriginal community controlled health organization in New South Wales, Australia.Results. Among 387 enrolled participants, mean age was 41 years, 71% were male, and 15% were of Aboriginal ethnicity. Specialist assessment was undertaken in 191 (49%) participants, and 84 (22%) commenced interferon-based treatment. In adjusted analysis, HCV specialist assessment was associated with non-Aboriginal ethnicity (adjusted odds ratio [AOR], 4.02; 95% confidence interval [CI], 2.05-7.90), no recent benzodiazepine use (AOR, 2.06; 95% CI, 1.31-3.24), and non-1 HCV genotype (AOR, 2.13; 95% CI, 1.32-3.43). In adjusted analysis, HCV treatment was associated with non-Aboriginal ethnicity (AOR, 4.59; 95% CI, 1.49-14.12), living with the support of family and/or friends (AOR, 2.15; 95% CI, 1.25-3.71), never receiving OST (AOR, 4.40; 95% CI, 2.27-8.54), no recent methamphetamine use (AOR, 2.26; 95% CI, 1.12-4.57), and non-1 HCV genotype (AOR, 3.07; 95% CI, 1.67-5.64).Conclusions. HCV treatment uptake was relatively high among this highly marginalized population of PWID. Potentially modifiable factors associated with treatment include drug use and social support.