Facente Consulting, Richmond, California, United States of America.
University of California, San Francisco, San Francisco, California, United States of America.
PLoS One. 2018 Apr 11;13(4):e0195575. doi: 10.1371/journal.pone.0195575. eCollection 2018.
Initiated in 2016, End Hep C SF is a comprehensive initiative to eliminate hepatitis C (HCV) infection in San Francisco. The introduction of direct-acting antivirals to treat and cure HCV provides an opportunity for elimination. To properly measure progress, an estimate of baseline HCV prevalence, and of the number of people in various subpopulations with active HCV infection, is required to target and measure the impact of interventions. Our analysis was designed to incorporate multiple relevant data sources and estimate HCV burden for the San Francisco population as a whole, including specific key populations at higher risk of infection.
Our estimates are based on triangulation of data found in case registries, medical records, observational studies, and published literature from 2010 through 2017. We examined subpopulations based on sex, age and/or HCV risk group. When multiple sources of data were available for subpopulation estimates, we calculated a weighted average using inverse variance weighting. Credible ranges (CRs) were derived from 95% confidence intervals of population size and prevalence estimates.
We estimate that 21,758 residents of San Francisco are HCV seropositive (CR: 10,274-42,067), representing an overall seroprevalence of 2.5% (CR: 1.2%- 4.9%). Of these, 16,408 are estimated to be viremic (CR: 6,505-37,407), though this estimate includes treated cases; up to 12,257 of these (CR: 2,354-33,256) are people who are untreated and infectious. People who injected drugs in the last year represent 67.9% of viremic HCV infections.
We estimated approximately 7,400 (51%) more HCV seropositive cases than are included in San Francisco's HCV surveillance case registry. Our estimate provides a useful baseline against which the impact of End Hep C SF can be measured.
2016 年启动的“终结旧金山丙型肝炎”（End Hep C SF）是一项旨在消除旧金山丙型肝炎（HCV）感染的综合倡议。直接作用抗病毒药物的引入为治疗和治愈 HCV 提供了机会。为了正确衡量进展，需要估计基线 HCV 流行率以及各种亚人群中具有活动性 HCV 感染的人数，以确定目标并衡量干预措施的影响。我们的分析旨在整合多个相关数据源，并估计整个旧金山人群的 HCV 负担，包括感染风险较高的特定关键人群。
我们的估计基于 2010 年至 2017 年期间从病例登记处、医疗记录、观察性研究和已发表文献中找到的数据进行三角测量。我们根据性别、年龄和/或 HCV 风险组检查亚人群。当有多个数据来源可用于亚人群估计时，我们使用倒数方差加权法计算加权平均值。可信度区间（CR）源自人群规模和流行率估计的 95%置信区间。
我们估计旧金山有 21758 名居民 HCV 血清阳性（CR：10274-42067），总血清阳性率为 2.5%（CR：1.2%-4.9%）。其中，估计有 16408 人病毒血症（CR：6505-37407），但这一估计包括治疗病例；其中多达 12257 人（CR：2354-33256）是未经治疗且具有传染性的人。在过去一年中曾注射毒品的人占病毒血症 HCV 感染的 67.9%。
我们估计 HCV 血清阳性病例比旧金山 HCV 监测病例登记处多约 7400 例（51%）。我们的估计提供了一个有用的基线，可以衡量“终结旧金山丙型肝炎”倡议的影响。
