It may take many villages, but progress can be made toward HCV elimination among people who inject drugs.
It may take many villages, but progress can be made toward HCV elimination among people who inject drugs.
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DOI：
10.1016/j.lana.2023.100510
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发表时间：
2023-06
期刊：
影响因子：
--
通讯作者：
Page, Kimberly
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文献类型：
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作者：
Page, Kimberly
治疗障碍继续限制为许多慢性丙型肝炎病毒（HCV）感染者提供和接受高效治疗。在美国，值得注意的障碍包括患者层面（例如，难以获得医疗保健，缺乏医疗保险，诊断和治疗率低，以及担心歧视）和系统层面（例如成本和行政规则，包括事先授权的要求，禁止使用药物和酒精，以及处方限制等1）。在全球范围内，PWID（注射毒品的人）中HCV感染的高患病率保证了HCV治疗的新方法，以减少患病率和持续传播。2尽管有研究表明，HCV感染的PWID可以参与并成功治疗HCV，但从诊断到持续病毒学应答，个体接受HCV治疗必须经历的护理级联或步骤顺序并不乐观。6-8尽管缺乏协调一致的人口水平方法，但专门和创造性的团体正在取得小幅度的进展，以测试和提供对残疾人的护理模式。在本期《柳叶刀区域健康-美洲》中，Lettner等人，9目前的结果来自加拿大多伦多的一个新项目，该项目汇集了许多根据需要提出的改善PWID中HCV治疗吸收和完成的要素：获得检测和药物、综合护理、信任和社区支持。10作者将该项目描述为低障碍，尽管患者确实面临许多障碍，但该项目为PWID的成功HCV治疗项目提供了必要的策略。在这项研究中，这是在一个监督消费服务称为“keepSIX”，实施了一项HCV治疗计划，提供即时护理（POC）HCV RNA检测，现场提供者包括护士和医生谁可以进行预处理评估和处方和分发药物。总的来说，在64例HCV RNA阳性的参与者中，89%（57/64）符合治疗条件，67.2%（43/64）与同地HCV护理（与健康中心的HCV治疗护士一起接受治疗）有关。在与现场HCV治疗有关的参与者中，67.4%（29/43）开始治疗，86.2%（25/29）达到SVR。总体而言，相当大比例的合格患者-43.9%（25/57）治愈了HCV感染，证明了成功的HCV治疗模式。这一成功是值得注意的，因为参与者面临着许多相同的障碍，特别是在系统层面，现存的医疗保健系统。”低障碍”一词用于描述计划或服务，这些计划或服务旨在为可能面临接受医疗保健障碍（如财务或后勤障碍）的个人提供方便和可用的服务。然而，在某些情况下，以”低障碍”销售的计划或服务实际上可能不是低障碍。本研究中的HCV感染者仍需在参考实验室进行确证性HCV RNA检测，并在间隔6个月内进行连续两次阳性HCV RNA检测，以确认慢性HCV病毒血症。此外，该研究受到COVID-19大流行的影响，这对各地的医疗服务提出了挑战。从首次HCV RNA检测阳性到联系治疗的中位时间为63天（IQR：6-230天），首次HCV RNA检测阳性到开始治疗的中位时间为265天（IQR：177-503天）。尽管存在这些缺点，但该计划为低障碍HCV治疗提供了必要的关键因素，需要强调。（1.
Treatment barriers continue to limit provision and uptake of highly effective treatment for many people with chronic hepatitis C virus (HCV) infection. In the United States, notable barriers include both patient level (for example, poor access to healthcare, lack of health insurance, low diagnosis and treatment uptake rates, and fear of discrimination), and system level (such as costs and administrative rules, including requirements for prior authorizations, abstinence from substance use and alcohol, and prescriber restrictions, among others 1). The high prevalence of HCV infection among PWID (People Who Inject Drugs), globally, warrants novel approaches to HCV treatment to reduce prevalence and ongoing transmission. 2 The cascade of care, or sequence of steps that individuals must go through to receive HCV treatment, from diagnosis to sustained virologic response is not promising, 3–5 despite studies showing that PWID with HCV can be engaged and successfully treated for HCV. 6–8 Notwithstanding the lack of concerted population level approaches to, progress is being made in small increments by dedicated and creative groups to test and provide models of care for PWID. In this issue of Lancet Regional Health-Americas, Lettner et al., 9 present results from a novel program in Toronto, Canada, that brings together many of the elements proposed as needed to improve HCV treatment uptake and completion among PWID: access to testing and medication, integrated care, trust, and community support. 10 The authors describe the program as low barrier-and although patients did actually face many barriers, the program provides essential strategies for successful HCV treatment programs for PWID. In this study, which was conducted at a Supervised Consumption Service called “keepSIX”, an HCV treatment program was implemented that offered point-ofcare (POC) HCV RNA testing, on-site providers including nurses and physicians who could conduct pretreatment assessments and prescribe and dispense medications. Overall, among 64 participants who were HCV RNA positive, 89%(57/64) were eligible for treatment, 67.2%(43/64) were linked to co-located HCV care (intake with the health center’s HCV Treatment Nurse).Of those linked to onsite HCV treatment, 67.4%(29/43) initiated treatment, and 86.2%(25/29) achieved SVR. Overall, a substantial proportion-43.9%(25/57) of those eligible were cured of HCV infection, demonstrating a successful HCV treatment model. This success is notable since the participants faced many of the same barriers-especially at the system-level-extant in healthcare systems. The term" low barrier" is used to describe programs or services that are designed to be easily accessible and available to individuals who may face obstacles to receiving healthcare, such as financial or logistical barriers. However, there are situations where a program or service that is marketed as" low barrier" may not actually be low barrier in practice. Participants with HCV in this study were still required to have confirmatory HCV RNA testing from a reference laboratory, and to have two consecutive positive HCV RNA tests six months apart for confirmation of chronic HCV viremia. Further, the study was impacted by the COVID-19 pandemic, which challenged healthcare delivery everywhere. The median time from first positive HCV RNA test to linkage to care was 63 days (IQR: 6–230 days), and the median time between first positive HCV RNA test and treatment initiation was 265 days (IQR: 177–503 days). Despite these drawbacks, the program offered key factors necessary for low-barrier HCV treatment access which need to be highlighted.(1 …
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