Simmons R, Ireland G, Irving W, Hickman M, Sabin C, Ijaz S, Ramsay M, Lattimore S, Mandal S
Immunisation, Hepatitis, and Blood Safety Department, Public Health England, London, UK.
The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.
J Viral Hepat. 2018 May;25(5):482-490. doi: 10.1111/jvh.12844. Epub 2018 Mar 15.
Little is known about engagement and retention in care of people diagnosed with chronic hepatitis C (HCV) in England. Establishing a cascade of care informs targeted interventions for improving case finding, referral, treatment uptake and retention in care. Using data from the sentinel surveillance of blood-borne virus (SSBBV) testing between 2005 and 2014, we investigate the continuum of care of those tested for HCV in England. Persons ≥1 year old with an anti-HCV test and subsequent RNA tests between 2005 and 2014 reported to SSBBV were collated. We describe the cascade of care, as the patient pathway from a diagnostic test, referral into care, treatment and patient outcomes. Between 2005 and 2014, 2 390 507 samples were tested for anti-HCV, corresponding to 1 766 515 persons. A total of 53 038 persons (35 190 men and 17 165 women) with anti-HCV positive were newly reported to SSBBV. An RNA test was conducted on 77.0% persons who were anti-HCV positive, 72.3% of whom were viraemic (RNA positive) during this time period, 21.4% had evidence of treatment and 3130 49.5% had evidence of a sustained virological response (SVR). In multivariable models, confirmation of viraemia by RNA test varied by age and region/test setting; evidence of treatment varied by age, year of test and region/test setting; and SVR varied by age, year of test and region/setting of test. In conclusion, our findings provide HCV cascade of care estimates prior to the introduction of direct acting antivirals. These findings provide important baseline cascade estimates to benchmark progress towards elimination of HCV as a major public health threat.
在英格兰，对于确诊为慢性丙型肝炎（HCV）患者的治疗参与度和持续性了解甚少。建立一系列的治疗环节有助于制定有针对性的干预措施，以改善病例发现、转诊、治疗接受情况和治疗持续性。利用2005年至2014年期间血源病毒哨点监测（SSBBV）检测的数据，我们调查了英格兰接受HCV检测者的连续治疗情况。整理了2005年至2014年期间向SSBBV报告的年龄≥1岁且进行过抗-HCV检测及后续RNA检测的人员信息。我们将一系列治疗环节描述为患者从诊断检测、转诊接受治疗到治疗结果的路径。2005年至2014年期间，共检测了2390507份抗-HCV样本，对应1766515人。共有53038人（35190名男性和17165名女性）抗-HCV呈阳性并新报告给SSBBV。77.0%抗-HCV呈阳性的人进行了RNA检测，在此期间，其中72.3%为病毒血症（RNA阳性），21.4%有治疗证据，49.5%有持续病毒学应答（SVR）证据。在多变量模型中，RNA检测确认病毒血症因年龄和地区/检测机构而异；治疗证据因年龄、检测年份和地区/检测机构而异；SVR因年龄、检测年份和检测地区/机构而异。总之，我们的研究结果提供了在直接作用抗病毒药物引入之前HCV一系列治疗环节的估计值。这些发现提供了重要的基线系列估计值，以衡量在消除HCV作为主要公共卫生威胁方面取得的进展。
