PDF(Pubmed)
Abstract：
Hepatitis C (HCV) reinfection studies have not focused on primary healthcare services in Australia, where priority populations including people who inject drugs (PWID) typically engage in healthcare. We aimed to describe the incidence of HCV reinfection and associated risk factors in a cohort of people most at risk of reinfection in a real-world community setting. We conducted a secondary analysis of routinely collected HCV testing and treatment data from treatment episodes initiated with direct-acting antiviral (DAA) therapy between October 2015 and June 2021. The overall proportion of clients (N = 413) reinfected was 9% (N = 37), and the overall incidence rate of HCV reinfection was 9.5/100PY (95% CI: 6.3-14.3). Reinfection incidence rates varied by sub-group and were highest for Aboriginal and/or Torres Strait Islander people (20.4/100PY; 95% CI: 12.1-34.4). Among PWID (N= 321), only Aboriginality was significantly associated with reinfection (AOR: 2.73, 95% CI: 1.33-5.60, p = 0.006). High rates of HCV reinfection in populations with multiple vulnerabilities and continued drug use, especially among Aboriginal and Torres Strait Islander people, highlight the need for ongoing regular HCV testing and retreatment in order to achieve HCV elimination. A priority is resourcing testing and treatment for Aboriginal and/or Torres Strait Islander people. Our findings support the need for novel and holistic healthcare strategies for PWID and the upscaling of Indigenous cultural approaches and interventions.
摘要：
丙型肝炎（HCV）再感染的研究没有集中在澳大利亚的初级医疗保健服务，包括注射毒品（PWID）在内的优先人群通常从事医疗保健。我们的目的是描述在现实世界社区环境中，HCV再感染的发生率和相关的危险因素。我们对2015年10月至2021年6月期间使用直接作用抗病毒（DAA）治疗开始的常规HCV检测和治疗数据进行了二次分析。再次感染的客户（N=413）的总比例为9％（N=37），HCV再感染的总发生率为9.5/100PY（95％CI：6.3-14.3）。再感染发生率因亚组而异，原住民和/或托雷斯海峡岛民的再感染发生率最高（20.4/100PY；95％CI：12.1-34.4）。在PWID(N=321)中，只有原住民与再感染显著相关(AOR:2.73,95%CI:1.33-5.60,p=0.006).在具有多种脆弱性和持续使用药物的人群中，HCV再感染率很高，尤其是原住民和托雷斯海峡岛民，强调需要进行定期HCV检测和再治疗，以实现HCV消除。优先事项是为原住民和/或托雷斯海峡岛民提供资源测试和治疗。我们的发现支持对PWID的新颖和整体医疗保健策略的需求以及土著文化方法和干预措施的升级。
