Safreed-Harmon Kelly, Hetherington Kristina L, Aleman Soo, Alho Hannu, Dalgard Olav, Frisch Tove, Gottfredsson Magnus, Weis Nina, Lazarus Jeffrey V
CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
PLoS One. 2018 Jan 30;13(1):e0190146. doi: 10.1371/journal.pone.0190146. eCollection 2018.
In the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden), the prevalence of chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a public health threat.
Fourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country.
Stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly.
The Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere.
在北欧国家（丹麦、芬兰、冰岛、挪威、瑞典），慢性丙型肝炎病毒（HCV）感染在普通人群中的患病率相对较低，但在注射吸毒者中要高得多。我们开展了一项探索性研究，以调查这些国家在多大程度上拥有支持公共卫生应对关键要素的政策，而这些政策对于实现消除HCV作为公共卫生威胁这一全球目标而言是必要的。
代表北欧国家政府机构、医学协会和民间社会组织（CSO）的14名利益相关者完成了一项横断面在线调查，该调查包含21个与国家协调、预防、检测、治疗衔接及治疗相关的政策问题。我们在描述性分析中总结了研究结果，并注意到同一国家内利益相关者的不同回答。
利益相关者报告称，五个研究国家中有三个国家拥有全国性病毒性肝炎战略，而只有冰岛有全国性消除HCV目标。减少伤害服务的可及性各不相同，所有国家都为普通人群提供阿片类药物替代疗法，但未提供针头和注射器项目。没有一个国家在全国所有地区都能进行匿名HCV检测。除芬兰外，所有国家都有全国性HCV治疗指南，且所有国家都提供公共资金支持的直接抗病毒治疗。各国在政策方面存在分歧，CSO是回答调查问题错误最频繁的利益相关者群体。
尽管这些国家的注射吸毒者中存在大规模HCV流行，但北欧地区作为一个整体并未始终如一地表明其应对HCV的决心。利益相关者的一致性以及既定的消除目标及相应的战略和实施计划，应被视为北欧地区及其他地区为实现HCV消除而进行全国性公共卫生协调努力的基础。
