基于监测的纽约市丙型肝炎治疗和治愈估计算法的开发和验证。
Development and Validation of Surveillance-Based Algorithms to Estimate Hepatitis C Treatment and Cure in New York City.
机构信息
Viral Hepatitis Program (Mss Moore, Bocour, and Jordan and Drs Winters and Laraque), New York City Department of Health and Mental Hygiene, Division of Disease Control (Dr Varma), Bureau of Communicable Diseases (Ms McGibbon), Queens, New York. Dr Varma is now with the Africa CDC, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia. Dr Laraque is now with the New York City Department of Homeless Services, New York, New York.
出版信息
J Public Health Manag Pract. 2018 Nov/Dec;24(6):526-532. doi: 10.1097/PHH.0000000000000688.
CONTEXT
Treatment options for chronic hepatitis C virus (HCV) have improved in recent years. The burden of HCV in New York City (NYC) is high. Measuring treatment and cure among NYC residents with HCV infection will allow the NYC Department of Health and Mental Hygiene (DOHMH) to appropriately plan interventions, allocate resources, and identify disparities to combat the hepatitis C epidemic in NYC.
OBJECTIVE
To validate algorithms designed to estimate treatment and cure of HCV using RNA test results reported through routine surveillance.
DESIGN
Investigation by NYC DOHMH to determine the true treatment and cure status of HCV-infected individuals using chart review and HCV test data. Treatment and cure status as determined by investigation are compared with the status determined by the algorithms.
SETTING
New York City health care facilities.
PARTICIPANTS
A total of 250 individuals with HCV reported to the New York City Department of Health and Mental Hygiene (NYC DOHMH) prior to March 2016 randomly selected from 15 health care facilities.
MAIN OUTCOME MEASURES
The sensitivity and specificity of the algorithms.
RESULTS
Of 235 individuals successfully investigated, 161 (69%) initiated treatment and 96 (41%) achieved cure since the beginning of 2014. The treatment algorithm had a sensitivity of 93.2% (95% confidence interval [CI], 89.2%-97.1%) and a specificity of 83.8% (95% CI, 75.3%-92.2%). The cure algorithm had a sensitivity of 93.8% (95% CI, 88.9%-98.6%) and a specificity of 89.4% (95% CI, 83.5%-95.4%). Applying the algorithms to 68 088 individuals with HCV reported to DOHMH between July 1, 2014, and December 31, 2016, 28 392 (41.7%) received treatment and 16 921 (24.9%) were cured.
CONCLUSIONS
The algorithms developed by DOHMH are able to accurately identify HCV treatment and cure using only routinely reported surveillance data. Such algorithms can be used to measure treatment and cure jurisdiction-wide and will be vital for monitoring and addressing HCV. NYC DOHMH will apply these algorithms to surveillance data to monitor treatment and cure rates at city-wide and programmatic levels, and use the algorithms to measure progress towards defined treatment and cure targets for the city.
背景
近年来，慢性丙型肝炎病毒（HCV）的治疗选择有所改善。纽约市（NYC）HCV 的负担很高。衡量 NYC 居民 HCV 感染者的治疗和治愈率，将使纽约市卫生与心理卫生局（DOHMH）能够适当规划干预措施、分配资源和确定差距，以对抗 NYC 的丙型肝炎流行。
目的
通过常规监测报告的 RNA 检测结果，验证用于估计 HCV 治疗和治愈率的算法。
设计
纽约市 DOHMH 开展调查，通过病历回顾和 HCV 检测数据确定 HCV 感染者的真实治疗和治愈率。通过调查确定的治疗和治愈率与算法确定的状态进行比较。
地点
纽约市医疗保健设施。
参与者
2016 年 3 月前向纽约市卫生与心理卫生局（NYC DOHMH）报告的 15 家医疗保健机构中随机选择的 250 名 HCV 患者。
主要观察指标
算法的灵敏度和特异性。
结果
在 235 名成功接受调查的患者中，自 2014 年初以来，161 名（69%）开始治疗，96 名（41%）治愈。治疗算法的灵敏度为 93.2%（95%可信区间[CI]，89.2%-97.1%），特异性为 83.8%（95%CI，75.3%-92.2%）。治愈率算法的灵敏度为 93.8%（95%CI，88.9%-98.6%），特异性为 89.4%（95%CI，83.5%-95.4%）。在 2014 年 7 月 1 日至 2016 年 12 月 31 日期间向 DOHMH 报告的 68088 名 HCV 患者中应用这些算法，28392 名（41.7%）接受了治疗，16921 名（24.9%）治愈。
结论
DOHMH 开发的算法仅使用常规报告的监测数据即可准确识别 HCV 的治疗和治愈率。这种算法可以用于衡量全市范围内的治疗和治愈率，并对 HCV 的监测和应对至关重要。NYC DOHMH 将在监测数据中应用这些算法，以监测全市和项目层面的治疗和治愈率，并使用这些算法衡量该市定义的治疗和治愈率目标的进展情况。
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