冰岛全国范围内消除丙型肝炎计划中丙型肝炎感染治疗效果的预测因素：丙型肝炎预防治疗（TraP HepC）研究。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2024-10-24 DOI:10.1016/j.drugpo.2024.104616

Sigurdur Olafsson , Thorvardur Jon Love , Ragnheidur Hulda Fridriksdottir , Thorarinn Tyrfingsson , Valgerdur Runarsdottir , Ingunn Hansdottir , Ottar Mar Bergmann , Einar Stefan Björnsson , Birgir Johannsson , Bryndis Sigurdardottir , Arthur Löve , Guðrún Erna Baldvinsdottir , Marianna Thordardottir , Ubaldo Benitez Hernandez , Maria Heimisdottir , Margaret Hellard , Magnus Gottfredsson , the TraP Hep C working group

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引用次数: 0

摘要

背景：在以注射吸毒（IDU）为主要传播方式的全国性丙型肝炎病毒（HCV）消除计划中，有关治疗效果的数据十分有限。2016 年，冰岛启动了名为 "丙型肝炎预防治疗"（TraP HepC）的丙型肝炎病毒消除计划。本文研究了该人群中与丙型肝炎病毒治愈相关的因素：方法：不受限制地提供直接作用抗病毒药物（DAAs）。扩大了检测和减低危害的范围，并为未治愈者提供再治疗。对最初 36 个月的治愈率进行了评估，并使用多变量逻辑回归分析了与未能治愈相关的因素：718人接受了治疗，705人同意参加研究。中位年龄为 44 岁（IQR 35-56），593 人（84.1%）报告有注射吸毒史，234 人（33.2%）近期有注射吸毒史；48 人（6.8%）无家可归。在 705 名患者中，有 635 人（90.1%）在首次治疗中治愈。共有 70 名患者（9.9%）接受了两次或两次以上的治疗，结果有 673 人治愈（95.5%）。通过多变量分析，无家可归是与首次治疗后未治愈相关的唯一具有统计学意义的独立因素（OR 2.67，95 % CI 1.32-5.41）：结论：通过重新参与治疗并在必要时及时进行再治疗，治愈率达到了 95.5%。住房不稳定是导致疗效不佳的潜在因素。

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Predictors of treatment outcomes for Hepatitis C infection in a nationwide elimination program in Iceland: The treatment as prevention for Hepatitis C (TraP HepC) study

Background

Limited data exists about treatment outcomes in nationwide hepatitis C virus (HCV) elimination programs where injection drug use (IDU) is the main mode of transmission. In 2016 Iceland initiated the HCV elimination program known as Treatment as Prevention for Hepatitis C (TraP HepC). Factors associated with HCV cure in this population are examined.

Methods

Unrestricted access was offered to direct acting antiviral agents (DAAs). Testing and harm reduction was scaled up and re-treatments were offered for those who did not attain cure. Cure rates for the first 36 months were assessed and factors associated with failure to achieve cure analysed using multivariable logistic regression.

Results

Treatment was initiated for 718; 705 consented for the study. Median age was 44 years (IQR 35–56), history of IDU reported by 593 (84.1 %), recent IDU by 234 (33.2 %); 48 (6.8 %) were homeless. Of 705 patients, 635 achieved cure (90.1 %) during the first treatment. A total of 70 (9.9 %) patients initiated two or more treatments, resulting in 673 participants cured (95.5 %). By multivariable analysis, homelessness was the only statistically significant independent factor associated with not achieving cure (OR 2.67, 95 % CI 1.32–5.41) after first treatment attempt.

Conclusion

By reengagement in care and prompt retreatment when needed, a cure rate of 95.5 % was achieved. Unstable housing, a potentially actionable factor is associated with poor outcome.

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.