Psychosocial Factors and the Care Cascade for Hepatitis C Treatment Colocated at a Syringe Service Program
Psychosocial Factors and the Care Cascade for Hepatitis C Treatment Colocated at a Syringe Service Program
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DOI：
10.1093/infdis/jiaa142
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发表时间：
2020-10-01
影响因子：
6.4
通讯作者：
Scherer, Matthew
中科院分区：
文献类型：
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作者：
Winetsky, Daniel;Burack, Daniel;Scherer, Matthew
背景。直接作用抗病毒（DAA）治疗丙型肝炎病毒（HCV）非常有效。然而，注射吸毒者在获得 DAA 方面面临重大障碍。方法。我们描述了一个将 HCV 管理纳入纽约市注射器服务项目中的项目。我们对所有确诊为 HCV 病毒血症的患者进行了回顾性图表审查。结果。 2015年至2018年，102名病毒血症患者完成摄入。 58 名患者开始接受 DAA。九名患者在完成前停止治疗或失访； 1正在继续DAA治疗。在完成治疗的 48 名患者中，43 名患者（89.6%）实现了持续病毒学缓解 (SVR)。年龄和入院时已接受的心理健康治疗与 SVR 相关。在单变量分析中，经常使用可卡因与 SVR 呈负相关，但在调整年龄后这种相关性并不显着。在完成 DAA 治疗的 30 名患者中，14 名患者（46.4%）在治疗期间接受了阿片类药物使用障碍（OUD）治疗，9 名患者在完成 DAA 治疗后仍接受 OUD 治疗。结论。失访对于注射吸毒者来说是一个挑战，但在完成治疗的人中，SVR 的实现率很高。心理健康治疗可能有助于丙肝病毒的治愈。相反，HCV 治疗可能有助于参与 OUD 治疗和其他服务。
Background. Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is highly effective. However, people who inject drugs face significant barriers to DAA access.Methods. We describe a program that colocates HCV management within a syringe service program in New York City. We performed a retrospective chart review of all patients with confirmed HCV viremia.Results. From 2015 to 2018, 102 patients with viremia completed intake. Fifty-eight patients started DAAs. Nine patients discontinued treatment or were lost to follow-up before completion; 1 is continuing DAA treatment. Of 48 patients who completed therapy, sustained virologic response (SVR) was achieved in 43 (89.6%). Age and established mental health treatment at intake were associated with SVR. Regular cocaine use was negatively associated with SVR in univariate analysis, but this association was not significant after adjustment for age. Of 30 patients completing DAA therapy with active illicit opioid use at intake, 14 (46.4%) engaged in opioid use disorder (OUD) treatment during therapy, and 9 remained in OUD treatment after completion of DAA treatment.Conclusions. Loss to follow-up is a challenge for people who inject drugs, but among those who completed treatment, SVR was achieved at a high rate. Mental health treatment may facilitate HCV cure. Conversely, HCV therapy may facilitate engagement in OUD treatment and other services.