治愈和预防干预措施对注射药物的人群中乙型肝炎消除的潜在影响 - 一个网络建模研究
Lin Zhu1, William W Thompson2, Liesl Hagan2
1Department of Global Health and Population, Harvard T. H. Chan School of Public, Boston, MA, USA; Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA.
直接作用的抗病毒疗法显著降低了注射药物使用者 (PWID) 中的C型肝炎病毒 (HCV) 流行率. 结合治疗和预防干预措施,特别是针对那些有更多伴侣的人,是消除HCV的关键.
科学领域:
- 流行病学 流行病学
- 公共卫生 公共卫生
- 网络科学 网络科学
背景情况:
- 肝炎C病毒 (HCV) 传播与注射药物使用者 (PWID) 之间的注射设备共享网络密切相关.
- 直接作用抗病毒 (DAA) 治疗和预防干预措施对于消除HCV至关重要,但它们在各种PWID网络中的影响需要进一步了解.
研究的目的:
- 在PWID网络中建模治疗和预防干预对HCV传播的影响.
- 为了比较随机与基于程度的干预分配的有效性.
- 评估干预覆盖水平对HCV流行和发病率的影响.
主要方法:
- 使用美国农村PWID数据开发和校准了一种基于代理的HCV传播网络模型.
- 治疗和预防干预的模拟年覆盖率为12.5%,25%和37.5%.
- 干预被随机分配或通过针对PWID与更多注射合作伙伴 (基于程度) 的干预.
主要成果:
- 在37.5%的覆盖率下,结合治疗和预防干预,并根据程度分配,在两年内将HCV流行率降低了67%,发病率降低了70%.
- 治疗干预措施在降低患病率方面比预防性干预措施有效6-12倍,而两者对发病率的影响相似.
- 干预的影响与覆盖率几乎是线性的,基于学位的分配始终优于随机分配.
结论:
- 直接作用的抗病毒疗法有效降低HCV流行率和PWID的发病率.
- 预防性干预对于减少发病率至关重要,特别是在较低的覆盖率水平.
- PWID网络结构,干预覆盖范围和有针对性的分配是成功的型肝炎消除计划的关键因素.
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