The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy
The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy
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DOI：
10.1186/s12889-016-3784-4
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发表时间：
2016-11-02
影响因子：
4.5
通讯作者：
Moscoso Naveira, Marcelo Contardo
中科院分区：
文献类型：
--
作者：
Mesquita, Fabio;Santos, Melina Erica;Moscoso Naveira, Marcelo Contardo
背景：全球有超过1.85亿人感染丙型肝炎。这种沉默的疾病每年造成多达70万人死亡。尽管诊断和治疗方面的科学革命，但由于有效药物的成本，丙型肝炎的控制仍然是一个巨大的挑战。为了应对全球对丙型肝炎疫情的强烈抗议和改善国家公共卫生应对的需要，巴西卫生部对丙型肝炎的治疗进行了革命性的改革，纳入了可以通过可持续和普遍的手段获得的高效药物。讨论：本文描述了通过更新巴西丙型肝炎治疗的循证政策来应对丙型肝炎疫情的独特过程，该政策基于对疾病流行率的估计、当前的国际指南以及巴西统一卫生系统的成本效益影响。通过对一份经验报告的辩论，作者提出了根据形势分析执行的战略计划，其中强调需要在相对较短的时期内改进目前的应对措施。全面的应对措施包括三个主要目标：以可持续的价格评估和纳入新的有效药物以改善治疗结果；详细说明治疗丙型肝炎患者的临床指南；以及针对感兴趣的人群开展提高认识和诊断运动。在这种情况下，巴西为一个中高收入国家获得了前所未有的折扣；在2015年最后两个月为7000多人提供了治疗；预计2016年将治疗38000名新患者。摘要：巴西采用的非凡进程是根据流行病学数据和科学证据制定的，其动机是该国参与可持续发展目标，这可能会激励其他发展中国家找到到2030年实现这些目标的方法。
Background: Hepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications. In response to the global outcry of hepatitis epidemic and the need to improve the nation's public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means.Discussion: This paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016.Summary: The remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.