Delivering direct acting antiviral therapy for hepatitis C to highly marginalised and current drug injecting populations in a targeted primary health care setting
Delivering direct acting antiviral therapy for hepatitis C to highly marginalised and current drug injecting populations in a targeted primary health care setting
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DOI：
10.1016/j.drugpo.2017.05.032
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发表时间：
2017-09-01
影响因子：
4.4
通讯作者：
van Beek, Ingrid
中科院分区：
文献类型：
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作者：
Read, Phillip;Lothian, Rebecca;van Beek, Ingrid
背景资料：柯克顿路中心（KRC）是澳大利亚悉尼的一个社区公共卫生机构，为注射毒品（PWID）的人提供医疗保健，包括丙型肝炎病毒（HCV）治疗。从2016年3月起，澳大利亚政府为患有慢性丙型肝炎病毒的成年人提供直接作用抗病毒药物（DAA），而不受肝脏疾病阶段或药物和酒精使用限制。本研究的目的是报告DAA治疗的结果高度边缘化的PWID治疗KRC.Methods：所有个人开始DAA治疗KRC和持续病毒学应答（SVR 12）测试到2016年底。记录人口统计学、药物使用行为、临床参数、依从性支持和HCV治疗结局，包括SVR 12。通过多变量分析评估与SVR 12、失访（LTFU）和延迟SVR 12检测（> SVR 16）相关的因素。SVR 12进行了评估的意向治疗（ITT）和修改ITT，后者不包括个人的治疗结束反应（ETR），但没有SVR 12评估，或推迟他们的SVR 12日期由于治疗interruption.Results：共72个人开始DAA，其中67%是男性，30%无家可归，32%原住民。所有人都有注射毒品的终身史，75%在过去六个月内注射过，44%至少每周注射一次; 25%还参加了阿片类药物替代治疗。25（35%）个人选择接受增强的坚持支持包。72名应接受SVR 12的受试者中有59名（82%）参加了检测，其中59/59名（100%）达到了SVR，ITT SVR为82%。另有6名患者在ETR时检测不到HCV RNA，但未进行SVR 12评估，1名患者中断治疗，mITT SVR为91%。无家可归与延迟的SVR 12测试相关（OR 24.9 95%CI 2.9-212.8，p = 0.003）。LTFU和药物注射的频率，最后注射的药物，或计划的治疗持续时间之间没有关联。结论：本研究证实，PWID可以成功地治疗HCV在现实世界中的设置使用一个综合的初级卫生保健模式。它还证明了在高风险PWID人群中升级DAA治疗的可行性，具有潜在的个人和人群水平的公共卫生益处。需要加强努力，以优化治疗后的后续行动。(C)2017爱思唯尔B. V.保留所有权利。
Background: The Kirketon Road Centre (KRC) is a community-based public health facility in Sydney, Australia, that provides healthcare to people who inject drugs (PWID), including hepatitis C virus (HCV) treatment. From March 2016, the Australian Government has provided access to direct-acting antivirals (DAA) for adults with chronic HCV, without liver disease stage or drug and alcohol use restrictions. The aim of this study was to report DAA treatment outcomes among highly marginalised PWID treated at KRC.Methods: All individuals initiating DAA treatment at KRC and due for sustained virological response (SVR12) testing by end 2016 were included. Demographic, drug use behaviour, clinical parameters, adherence support and HCV treatment outcomes, including SVR12 were recorded. Factors associated with SVR12, loss-to-follow-up (LTFU) and delayed SVR12 testing (>SVR16) were assessed by multivariate analysis. SVR12 was assessed by intention-to-treat (ITT) and modified ITT, the latter excluding individuals with an end-of-treatment response (ETR) but no SVR12 assessment, or who postponed their SVR12 date due to treatment interruption.Results: A total of 72 individuals commencing DAAs were included, of whom 67% were male, 30% homeless, and 32% Aboriginal. All had a lifetime history of injecting drug use, with 75% having injected within the last six months, and 44% injecting at least weekly; 25% were also enrolled in opioid substitution therapy. Twenty-five (35%) individuals elected to receive an enhanced adherence-support package. Fifty-nine of 72 (82%) individuals due for SVR12 attended for testing, of whom 59/59 (100%) achieved SVR, providing an ITT SVR of 82%. A further six individuals had undetectable HCV RNA at ETR, but no SVR12 assessment, and one interrupted treatment, providing a mITT SVR of 91%. Homelessness was associated with delayed SVR12 testing (OR 24.9 95%CI 2.9-212.8, p = 0.003). There was no association between LTFU and frequency of drug injection, last drug injected, or planned treatment duration.Conclusion: This study confirms that PWID can be successfully treated for HCV in a real-world setting using an integrated primary health care model. It also demonstrates feasibility to upscale DAA therapy in high risk PWID populations, with potential individual and population-level public health benefits. Enhanced efforts are required to optimise post-treatment follow-up. (C) 2017 Elsevier B.V. All rights reserved.