Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepatitis C virus infection
Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepatitis C virus infection
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DOI：
10.1016/j.drugpo.2007.01.009
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发表时间：
2007-10-01
影响因子：
4.4
通讯作者：
Conwaya, Brian
中科院分区：
文献类型：
--
作者：
Grebely, Jason;Genoway, Krista;Conwaya, Brian
注射吸毒是丙型肝炎病毒感染事件和流行病例的主要原因。然而，很少有注射吸毒者接受过这种情况的治疗，因为存在医疗或精神疾病并存、持续滥用药物的问题，而且人们普遍认为，这些人将无法遵守治疗要求，包括定期的医疗随访。考虑到这一点，我们试图评估参加每周同伴支持小组并接受直接观察的丙型肝炎病毒治疗的现任和前任注射吸毒者的丙型肝炎治疗摄取率和结果。利用现有的管理成瘾性疾病的基础设施，我们开发了一种“一站式购物”模式，在护士、咨询师、成瘾专家、传染病专家、初级保健医生和研究人员的合作下，将成瘾、丙型肝炎和其他医疗条件的治疗完全整合在一起。有兴趣接受丙型肝炎病毒感染治疗的受试者被转介到每周一次的同伴支持小组，并对治疗进行评估。患者接受聚乙二醇化干扰素-α2a或-α2b治疗，两者均与利巴韦林联合使用。所有注射均被直接观察到。总体而言，我们观察到参与者中接受丙型肝炎病毒治疗的比例很高，51%的患者正在接受或即将接受治疗。到目前为止，18名患者已经开始治疗丙型肝炎病毒感染，12名患者已经完成治疗。总体而言，8/12(67%)的受试者实现了治疗结束反应(基因1，67%；基因2/3，67%)，尽管75%的患者在治疗期间仍在使用药物。这些数据表明，有了适当的计划，被转介到同行支持小组的注射吸毒者可以实现对丙型肝炎治疗的高接受率。此外，可以在多学科DOT计划内成功地对目前和以前的注射吸毒者进行丙型肝炎病毒的治疗，从而产生与随机对照试验中报告的ETR相似的ETR。(C)2007 Elsevier B.V.保留所有权利。
Injection drug use accounts for the majority of incident and prevalent cases of hepatitis C virus (HCV) infection. However, very few injection drug users (IDUs) have received treatment for this condition given issues of medical or psychiatric co-morbidity, ongoing substance abuse and a widely held belief that such individuals will not be able to adhere to the requirements of therapy, including regular medical follow-up. With this in mind, we sought to evaluate HCV treatment uptake and outcomes among current and former IDUs attending a weekly peer support group and receiving directly observed HCV therapy. Utilizing the existing infrastructure for the management of addictive disease, we have developed a model of "one-stop shopping" whereby the treatment of addiction, HCV and other medical conditions are fully integrated, with the collaboration of nurses, counsellors, addiction specialists, infectious disease specialists, primary care physicians and researchers. Subjects interested in receiving treatment for HCV infection were referred to a weekly peer-support group and evaluated for treatment. Patients received therapy with pegylated interferon-alpha 2a or -alpha 2b, both in combination with ribavirin. All injections were directly observed. Overall, we observed a high uptake of HCV treatment among attendees, with 51 percent either receiving or about to receive therapy. To date, 18 patients have initiated treatment for HCV infection and 12 have completed therapy. Overall, 8/12 (67 percent) subjects achieved an end of treatment response (genotype 1, 67 percent; genotypes 2/3, 67 percent), despite ongoing drug use in 75 percent of patients during treatment. These data demonstrate that with the appropriate programs in place, a high uptake of HCV treatment can be achieved among IDUs referred to a peer-support group. Moreover, the treatment of HCV in current and former IDUs within a multidisciplinary DOT program can be successfully undertaken, resulting in ETRs similar to those reported in randomized controlled trials. (C) 2007 Elsevier B.V. All rights reserved.