Abstract
Background: Viral hepatitis C (HCV) represents one of major public health problem worldwide and also in the Czech Republic. There are the incidence of chronic hepatitis C is estimated in about 80,000 people, most of them (about 60 %) due to injecting drug use.
Clinically serious consequences (cirrhosis, liver failure, hepatocellular carcinoma) usually occur 20-30 years after infection. Global and national efforts to eliminate HCV are currently underway, focusing primarily on improving the quality of treatment continuity (sustainability, uninterrupted treatment) which involves ensuring the availability of testing for all patients, patients' involvement in their own treatment, sustaining treatment, achieving a response rate and the necessary follow-up care.
Objective: To analyze the HCV continuum of care in people who inject drugs (mapping testing rate, treatment uptake and treatment completion), and to describe the factors that affect this process. Based on the collected data, to formulate recommendations for addiction care professionals in order to improve HCV continuum of care.
Methodology: A questionnaire survey was conducted among clients of low-threshold contact centers for drug users in Prague. The research group consisted of a total of 60 randomly selected respondents, 20 from each of the three centers.
Data were analyzed using descriptive statistics. Data collection was carried out in August 2019.
Results: Out of the 60 respondents 37 (61.6 %) were tested for HCV during the last 12 months. Of them 25 clients (67.6 %) reported a reactive HCV test result.
Of them 22 were examined by a HCV treatment specialist (88 % positively tested) and chronic HCV infection was confirmed in 19 respondents (76 %), i.e. they were indicated for treatment. Treatment initiated in 11 respondents (57.9 % of clients with chronic HCV), and 9 (47.4 %) completed the treatment.
Time constrains, more important issues to deal with and fear of treatment were the most frequently reported reasons by those who interrupted the treatment process. Conclusion: Compared to previously published data on HCV treatment continuum in people who inject drugs in Czechia, the rates of the different stages of the cascade of care are higher and the results may indicate an improvement in the continuity of care in context of the ongoing HCV elimination campaign.
Research also confirmed the gaps representing barriers to access to care in the whole continuum of care from testing to adherence to treatment.