Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya.
Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya.
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在肯尼亚，接受同行病例管理者支持的直接观察治疗的注射药物患者中，丙型肝炎治愈的预测因素。
DOI：
10.1016/j.drugpo.2023.103959
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Kurth,AnnE
中科院分区：
文献类型：
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作者：
Akiyama,MatthewJ;Riback,LindseyR;Nyakowa,Mercy;Musyoki,Helgar;Lizcano,JohnA;Muller,Abbe;Zhang,Chenshu;Walker,JosephineG;Stone,Jack;Vickerman,Peter;Cherutich,Peter;Kurth,AnnE
背景与目标直接观察治疗 (DOT) 可最大限度地提高依从性并最大限度地减少治疗差距。同伴病例管理者 (PCM) 也显示出作为丙肝综合治疗策略的组成部分的前景。 DOT 和 PCM 支持尚未得到充分探索，特别是在低收入和中等收入国家 (LMIC)。本研究的目的是评估参加肯尼亚药物辅助治疗 (MAT) 和针头和注射器计划 (NSP) 站点的注射吸毒者 (PWID) 持续病毒学应答 (SVR) 的预测因素。方法我们在内罗毕和肯尼亚沿海地区招募了使用 MAT 和 NSP 的注射吸毒者。使用 PCM 支持的 DOT 使用雷迪帕韦/索磷布韦治疗注射吸毒者。我们使用双变量和多变量逻辑回归来检验社会人口统计学、行为和临床因素对 SVR 的影响。结果在 92 名开始 HCV 治疗的注射吸毒者中，79 名（86%）为男性，平均年龄为 36.3 岁（SD=±6.5）； 38 人 (41%) 艾滋病毒呈阳性，87 人 (95%) 报告在过去 30 天内注射吸毒。超过一半的参与者为基因型 1a (55%)，其次是基因型 4a (41%) 和混合型 1a/4a (3%)。大多数参与者中，85 人 (92%) 完成了治疗，79 人 (86%) 实现了 SVR。虽然社会人口统计学和行为因素（包括近期注射吸毒）与实现 SVR 没有显着相关，但完全依从性 (p=0.042)、服用剂量次数 (p=0.008) 和治疗完成 (p=0.001) 与实现 SVR 的较高几率相关。 结论 在 LMIC 环境中，采用 PCM 支持的 DOT 是注射吸毒者 HCV 治疗的有效模式。依从性是 SVR 最重要的驱动因素，这表明 DOT 和 PCM 支持可以克服可能限制依从性的其他因素。鉴于 NSP 和 MAT 的获取情况存在差异，而且 DOT 在资源有限的情况下可能无法持续，因此有必要开展进一步研究，以确定中低收入国家中其他 HCV 护理模式对注射吸毒者的有效性。
Background & AimsDirectly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya.MethodsWe recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR.ResultsAmong 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR.ConclusionsDOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.