Hepatitis C management and treatment among people who inject drugs in Italy: an exploratory pilot survey.

BackgroundPeople Who Use Drugs (PWID) play a crucial role in the goal of eradicating hepatitis C and, despite the high efficacy and tolerability of Direct Acting Antivirals, many PWID still have to be treated and there are many barriers that slow down the process. An exploratory pilot survey was conducted to determine service providers' current condition and the barriers experienced by PWID in accessing HCV treatment.  MethodsSeven selected clinical centres completed a 27-item online survey addressing the current treatment situation in PWID hepatitis C treatment, related barriers and linkage to care.  ResultThe survey mainly involved central-northern Italian clinical centres (71.4%), with less than 4 prescribers (71.4%) despite they are currently treating around 500-1000 patients for Hepatitis C (>50% current or former PWID). In most cases, they carried out the necessary checks (100% blood sample, 85.7% fibroscan and 43% ultrasound) in few visits (85.7%) to deliver drugs in about one month (71.4%). They all agree on the need for fast-track for PWID and therefore they are all engaged in dedicated projects. The commitment to eradication is, in most cases, based on personal efforts, which despite the few prescribers, the lack of institutional support (85.7%) and the impossibility to use simplification scores since prescription and drug delivery portals (AIFA and regional) still require a lot of information. Although the centres questioned express the need for a simplification of the bureaucratic processes, however, they scrupulously follow PWID. For 57.4% of the centres, Linkage to Care remains the most problematic moment, to follow equally the lack of a correct epidemiological estimate and the implementation of the harm reduction policies. Finally, most of the centres don’t find particular barriers related to PWID’s features, but analysing them individually the main ones are: the difficult social background, the reinfection risk and the patient’s poor motivation. ConclusionsThe needs emerged from this survey are: to work on PWID de-stigmatization, to simplify the prescription/drug delivery portals in order, to increase PWID social assistance network and institutions support in HCV eradication programs.  

BackgroundPeople Who Use Drugs (PWID) play a crucial role in the goal of eradicating hepatitis C and, despite the high efficacy and tolerability of Direct Acting Antivirals, many PWID still have to be treated and there are many barriers that slow down the process. An exploratory pilot survey was conducted to determine service providers' current condition and the barriers experienced by PWID in accessing HCV treatment.  MethodsSeven selected clinical centres completed a 27-item online survey addressing the current treatment situation in PWID hepatitis C treatment, related barriers and linkage to care.  ResultThe survey mainly involved central-northern Italian clinical centres (71.4%), with less than 4 prescribers (71.4%) despite they are currently treating around 500-1000 patients for Hepatitis C (>50% current or former PWID). In most cases, they carried out the necessary checks (100% blood sample, 85.7% fibroscan and 43% ultrasound) in few visits (85.7%) to deliver drugs in about one month (71.4%). They all agree on the need for fast-track for PWID and therefore they are all engaged in dedicated projects. The commitment to eradication is, in most cases, based on personal efforts, which despite the few prescribers, the lack of institutional support (85.7%) and the impossibility to use simplification scores since prescription and drug delivery portals (AIFA and regional) still require a lot of information. Although the centres questioned express the need for a simplification of the bureaucratic processes, however, they scrupulously follow PWID. For 57.4% of the centres, Linkage to Care remains the most problematic moment, to follow equally the lack of a correct epidemiological estimate and the implementation of the harm reduction policies. Finally, most of the centres don’t find particular barriers related to PWID’s features, but analysing them individually the main ones are: the difficult social background, the reinfection risk and the patient’s poor motivation. ConclusionsThe needs emerged from this survey are: to work on PWID de-stigmatization, to simplify the prescription/drug delivery portals in order, to increase PWID social assistance network and institutions support in HCV eradication programs.  

Keywords:PWID, key population, HCV elimination, health care provider, hepatitis C virus, injection drug use

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  DOI: 10.2147/TCRM.S409134

Elisabetta Teti, Hepatitis C management and treatment among people who inject drugs in Italy: an exploratory pilot survey. in "MISSION" 54/2020, pp , DOI: 10.3280/mis54-2020oa9744