Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia
Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia
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DOI：
10.1016/j.jhep.2019.11.019
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发表时间：
2020-04-01
影响因子：
25.7
通讯作者：
Nasrullah, Muazzam
中科院分区：
文献类型：
--
作者：
Averhoff, Francisco;Shadaker, Shaun;Nasrullah, Muazzam
背景与目的：作为丙型肝炎病毒感染高发区的格鲁吉亚，于2015年4月启动了全球首个国家丙型肝炎消除计划。一项关键战略是识别、治疗和治愈生活在该国的约15万丙型肝炎病毒感染者。我们报告了格鲁吉亚的经验所取得的进展和面临的主要挑战。方法：我们通过分析2015-2018年国家丙型肝炎筛查登记和治疗数据库中的关联数据，构建了一个护理级联。我们评估了反射性丙型肝炎核心抗原(HCVcAg)检测对病毒血症检测和治疗启动(即与护理挂钩)的影响。结果：截至2018年12月31日，1,101,530名成年人(占成年人口的39.6%)进行了丙型肝炎抗体筛查，其中98,430人(8.9%)检测为阳性。在检测为阳性的人中，78,484人(79.7%)接受了病毒血症检测，其中66,916人(85.3%)活动性丙型肝炎病毒感染检测为阳性。共有52,576名活动性丙型肝炎病毒感染者开始接受治疗，48,879人完成了疗程。在35,035名接受治愈测试(即持续病毒学应答[SVR])的人中，34,513人(98.5%)实现了SVR。2018年3月实施的反射性HCVcAg检测使抗-HCV筛查阳性者的每月病毒血症检测率增加了97.5%，但在确诊的病毒携带者中，治疗启动率下降了60.7%。结论：佐治亚州超过三分之一的丙型肝炎病毒感染者已被检测到，并与护理和治疗有关，但对其余丙型肝炎病毒感染者的识别和护理是具有挑战性的。新的干预措施，如用HCVcAg进行反射试验，可以提高病毒血症检测率，但可能会导致意想不到的后果，如治疗启动率下降。关联数据系统允许对护理级联进行定期审查，从而能够确定不足之处并制定纠正行动。报告摘要：本报告描述了格鲁吉亚消除丙型肝炎方案的进展情况，并强调了在全国范围内促进丙型肝炎病毒筛查和治疗启动的努力。格鲁吉亚在消除丙型肝炎方面取得了进展，治疗了50,000多人，约占感染人数的三分之一，并实现了98.5%的检测对象治愈。然而，识别感染者并将他们与护理联系起来仍然具有挑战性。增加诊断检测的新方法可能会在进一步的护理级联中产生意想不到的后果。由Elsevier B.V.代表欧洲肝脏研究协会出版。
Background & Aims: Georgia, with a high prevalence of HCV infection, launched the world's first national hepatitis C elimination program in April 2015. A key strategy is the identification, treatment, and cure of the estimated 150,000 HCV-infected people living in the country. We report on progress and key challenges from Georgia's experience.Methods: We constructed a care cascade by analyzing linked data from the national hepatitis C screening registry and treatment databases during 2015-2018. We assessed the impact of reflex hepatitis C core antigen (HCVcAg) testing on rates of viremia testing and treatment initiation (i.e. linkage to care).Results: As of December 31, 2018, 1,101,530 adults (39.6% of the adult population) were screened for HCV antibody, of whom 98,430 (8.9%) tested positive. Of the individuals who tested positive, 78,484 (79.7%) received viremia testing, of whom 66,916 (85.3%) tested positive for active HCV infection. A total of 52,576 people with active HCV infection initiated treatment and 48,879 completed their course of treatment. Of the 35,035 who were tested for cure (i.e., sustained virologic response [SVR]), 34,513 (98.5%) achieved SVR. Reflex HCVcAg testing, implemented in March 2018, increased rates of monthly viremia testing by 97.5% among those who screened positive for anti-HCV, however, rates of treatment initiation decreased by 60.7% among diagnosed viremic patients.Conclusions: Over one-third of people living with HCV in Georgia have been detected and linked to care and treatment, however, identification and linkage to care of the remaining individuals with HCV infection is challenging. Novel interventions, such as reflex testing with HCVcAg, can improve rates of viremia testing, but may result in unintended consequences, such as decreased rates of treatment initiation. Linked data systems allow for regular review of the care cascade, allowing for identification of deficiencies and development of corrective actions.Lay summary: This report describes progress inGeorgia's hepatitis C elimination programand highlights efforts to promote hepatitis C virus screening and treatment initiation on a national scale. Georgia has made progress towards eliminating hepatitis C, treating over 50,000 people, approximately one-third of the number infected, and achieving cure for 98.5% of those tested. However, identifying infected individuals and linking them to care remains challenging. Novel approaches to increase diagnostic testing can have unintended consequences further down the care cascade. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.