Impact of COVID-19 on global HCV elimination efforts
Impact of COVID-19 on global HCV elimination efforts
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DOI：
10.1016/j.jhep.2020.07.042
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发表时间：
2021-01-01
影响因子：
25.7
通讯作者：
Craxi, Antonio
中科院分区：
文献类型：
--
作者：
Blach, Sarah;Kondili, Loreta A.;Craxi, Antonio
背景与目的：在消除肝炎的关键时刻，2019年冠状病毒病（COVID-19）给国家卫生保健系统带来了巨大压力。数学模型可用于评估规划延迟对肝炎疾病负担的可能影响。本分析的目的是评估在肝炎消除计划中断3个月、6个月或1年后，HCV肝脏相关死亡和肝癌的增量变化。方法：对110个国家先前开发的模型进行了调整，以包括现状或“无延迟”情景和假设在2020年干预措施（筛查、诊断和治疗）出现重大中断的“1年延迟”情景。提取年度国家级模型结果，并使用加权平均值计算2020年至2030年的区域（世卫组织和世界银行收入组）和全球估计数。结果的增量年变化是通过从“1年延迟”估计中减去“无延迟”估计来计算的。结果：从2020年到2030年，与全球“无延迟”情景相比，“延迟1年”情景导致44,800例（95%不确定区间[UI]: 43,800-49,300）多肝细胞癌病例和72,300例（95%不确定区间：70,600-79,400）多肝脏相关死亡。大多数错过治疗的病例将发生在中低收入国家，而大多数肝细胞癌和肝脏相关死亡病例将发生在高收入国家。结论：COVID-19的影响超出了与暴露和感染相关的直接发病率和死亡率。为了减轻对病毒性肝炎规划的影响并减少延迟治疗造成的超额死亡率，决策者应在安全的情况下尽快优先考虑肝炎规划。摘要：COVID-19已导致许多肝炎消除规划放缓或完全停止。到2030年，肝炎诊断和治疗延迟1年可能导致全球新增4.48万例肝癌和7.23万例丙型肝炎死亡。各国已承诺到2030年消除肝炎，因此应尽快将注意力转移到肝炎规划上。(C) 2020欧洲肝脏研究协会。Elsevier B.V.版权所有。
Background & Aims: Coronavirus disease 2019 (COVID-19) has placed a significant strain on national healthcare systems at a critical moment in the context of hepatitis elimination. Mathematical models can be used to evaluate the possible impact of programmatic delays on hepatitis disease burden. The objective of this analysis was to evaluate the incremental change in HCV liver-related deaths and liver cancer, following a 3-month, 6-month, or 1-year hiatus in hepatitis elimination programs.Methods: Previously developed models were adapted for 110 countries to include a status quo or 'no delay' scenario and a '1-year delay' scenario assuming significant disruption in interventions (screening, diagnosis, and treatment) in the year 2020. Annual country-level model outcomes were extracted, and weighted averages were used to calculate regional (WHO and World Bank Income Group) and global estimates from 2020 to 2030. The incremental annual change in outcomes was calculated by subtracting the 'no-delay' estimates from the '1-year delay' estimates.Results: The '1-year delay' scenario resulted in 44,800 (95% uncertainty interval [UI]: 43,800-49,300) excess hepatocellular carcinoma cases and 72,300 (95% UI: 70,600-79,400) excess liver-related deaths, relative to the 'no-delay' scenario globally, from 2020 to 2030. Most missed treatments would be in lower-middle income countries, whereas most excess hepatocellular carcinoma and liver-related deaths would be among high-income countries.Conclusions: The impact of COVID-19 extends beyond the direct morbidity and mortality associated with exposure and infection. To mitigate the impact on viral hepatitis programming and reduce excess mortality from delayed treatment, policy makers should prioritize hepatitis programs as soon as it becomes safe to do so.Lay Summary: COVID-19 has resulted in many hepatitis elimination programs slowing or stopping altogether. A 1-year delay in hepatitis diagnosis and treatment could result in an additional 44,800 liver cancers and 72,300 deaths from HCV globally by 2030. Countries have committed to hepatitis elimination by 2030, so attention should shift back to hepatitis programming as soon as it becomes appropriate to do so. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.