在高风险群体中参与HCV护理级联:基于人口的研究
Aysegul Erman1,2, Karl Everett2, William W L Wong1,2,3
1Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.
Hepatology communications
|August 9, 2023
概括
在安大略省,消除C型肝炎病毒 (HCV) 面临着挑战,治疗开始是一个关键的缺口. 改善HCV查和与危险人群的护理联系对于公平的结果至关重要.
科学领域:
- 肝病学和病毒性肝炎的研究研究.
- 公共卫生和流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 了解C型肝炎病毒 (HCV) 护理级联对于消除策略至关重要.
- 在直接作用抗病毒 (DAA) 时代,对加拿大安大略省的HCV护理级联的全面描述以前没有记录.
- 关键的风险人群,包括婴儿潮一代,移民和经历住房不稳定的个人,需要在HCV护理级联中特别注意.
研究的目的:
- 描述加拿大安大略省的人口级别的HCV护理级联.
- 根据关键风险群体对HCV护理级联进行分层:婴儿潮一代,移民和经历住房不稳定的个人.
- 确定参与不同阶段的HCV护理的人口统计和社会经济预测因素.
主要方法:
- 在1999年1月1日至2018年12月31日期间,使用安大略省居民的HCV检测数据进行了基于人口的队列研究.
- 绘制了HCV护理级联,包括抗体诊断,RNA测试,基因定型,治疗启动,持续的病毒学反应和再感染/复发.
- 使用因果特异性危险建模来确定HCV治疗连续性的参与预测因素.
主要成果:
- 在108,428名被诊断为HCV抗体的个人中,88%接受了RNA测试,62%的RNA测试呈阳性,其中94%的人具有基因型.
- 只有53%的确诊病毒病患者开始接受治疗,76%的患者获得持续的病毒学反应;大约1%的患者再次感染或复发.
- 在HCV护理级联中,男性,老年队列,长期居民,物质使用障碍或社会边缘化个体以及被诊断为DAA前时代的人群中观察到较低的参与率.
结论:
- 尽管在DAA时代取得了进展,但在开始HCV治疗方面仍然存在重大差距.
- 加强HCV查和改进的治疗策略是必要的,特别是对于有药物使用障碍和社会边缘化病史的人来说.
- 在安大略省,公平地弥补HCV治疗缺口需要针对弱势群体进行有针对性的干预.
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