Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there?
Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there?
复制标题
在2030年注射毒品的人们中，消除HCV是公共卫生的关注 - 到达那里需要什么？
DOI：
10.7448/ias.20.1.22146
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发表时间：
2017-07-28
影响因子：
6
通讯作者：
Klein MB
中科院分区：
文献类型：
--
作者：
Grebely J;Dore GJ;Morin S;Rockstroh JK;Klein MB
简介：在全球范围内，注射吸毒者（PWID）中的HCV和HIV感染负担相当大，这两种感染的传播仍在继续。针头和针筒方案和类阿片替代疗法的覆盖率仍然很低，尽管有证据表明它们具有预防效益。在PWID中HCV治愈率>95%的直接作用抗病毒疗法（DAA）提供了扭转HCV相关发病率和死亡率上升趋势并降低发病率的机会。然而，由于卫生系统，提供者，社会和患者的障碍，HCV检测，与护理和治疗的联系仍然很低。在2015年至2030年期间，世卫组织的目标包括将新的HCV感染减少80%，将HCV死亡减少65%，将HCV诊断率从<5%提高到90%，将接受HCV治疗的合格人数从<1%提高到80%。这篇评论讨论了为什么残疾人应被视为这些努力的优先人群，为什么这一目标可以在残疾人中实现，需要克服的挑战，以及关键的行动建议。讨论内容：在PWID中消除HCV作为全球健康问题的挑战包括减少危害服务的全球覆盖率低，限制性药物政策和药物使用的刑事定罪，获得卫生服务的机会少，HCV检测率低，与护理和治疗的联系，获得DAA治疗的限制，以及缺乏支持WHO消除目标的国家战略和政府投资。关键的行动建议包括改革毒品政策（使使用和/或持有毒品合法化，或为吸毒者提供监禁替代办法;使使用和提供消毒针头-注射器合法化;和阿片类药物依赖者阿片类药物合法化），增加和改善减少危害服务的资金，使残疾人能够获得保健服务，支持社区赋权和社区方案，改善获得负担得起的诊断和药物的机会，消除对残疾人的羞辱、歧视和暴力。结论：世卫组织制定的消除丙型肝炎病毒的宏伟目标在许多国家都是可以实现的，但需要世界各地的研究人员、医疗保健提供者、政策制定者、受影响社区、倡导者、制药和诊断行业以及政府共同努力才能实现。
Introduction: Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action. Discussion: Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID. Conclusions: The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.