Published:
[Erscheinungsort nicht ermittelbar]: Monash University. Faculty of Medicine, Nursing and Health Sciences. School of Public Health and Preventive Medicine, 2015
Language:
English
Origination:
University thesis:
Dissertation, Monash University. Faculty of Medicine, Nursing and Health Sciences. School of Public Health and Preventive Medicine, 2015
Footnote:
Description:
Worldwide, people who inject drugs (PWID) are a key population disproportionally affected by HIV and hepatitis C (HCV) primarily through the sharing of injecting equipment. Despite this, in Australia an early and continued comprehensive harm reduction response has resulted in HIV prevalence in PWID of 1-2%, HCV prevalence among PWID remains over 50%. This thesis sought to investigate the degree to which PWID are accepted into and progress through the continuum of effective HIV and HCV clinical care, as well as consider the impact of the current revolution in HCV small molecule antiviral therapy for PWID. A range of quantitative and qualitative methods were used to explore the relationship between PWID, HIV and HCV diagnosis, and treatment. The major findings of this thesis following an analysis of 3 longitudinal datasets in Victoria, Australia are that PWID are less likely to present late, and more likely to present early, for HIV diagnosis than non-injectors and that HIV-infected PWID in Victoria achieve equivalent HIV treatment outcomes following initiation of combination antiretroviral therapy (cART), including in their likelihood of obtaining HIV viral load suppression, compared with non-injectors. The thesis explored the utility of a HCV notification system in Victoria to identify PWID with newly acquired HCV and to link to treatment for acute HCV. While the rate of treatment uptake is low, this provides an epidemiological mechanism to confirm acute HCV diagnosis and link individuals to treatment. Qualitative methods were used to explore HCV interferon-based treatment for PWID in the community setting.While PWID find the current standard of care interferon-based HCV therapy challenging, there may be a positive subjective impact on substance use following completion of treatment. In addition, peer support for PWID is feasible and acceptable to PWID undergoing HCV treatment, is associated with high rates of treatment uptake and may assist with retention in community-based treatment settings. The current situation regarding PWID and new direct-acting antivirals (DAAs) was reviewed. Interferon-free regimens consisting of these new, highly effective DAAs have the potential to revolutionize HCV therapy. Despite being a key affected population, PWID are unlikely to benefit from these new treatments because of price and access barriers. Taken together, the findings of this thesis suggest that timely diagnosis and effective care and treatment of both HIV and HCV is possible for PWID, and potentially enhanced by peer workers attached to the clinical team in the context of treatment.