Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK.
Department of Gastroenterology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
J Viral Hepat. 2018 Dec;25(12):1438-1445. doi: 10.1111/jvh.12966. Epub 2018 Jul 30.
The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale-up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar-es-Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar-es-Salaam were obtained from records. In 2015, consecutive HCV-seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV-seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34-41), and 65 (44%) were co-infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar-es-Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania.
世界卫生组织最近呼吁消除丙型肝炎病毒（HCV），并将注射毒品者（PWID）确定为扩大筛查和联系护理的重点人群。本研究报告了在坦桑尼亚达累斯萨拉姆最大的阿片类物质替代治疗（OST）诊所就诊的 PWID 中 HCV 的护理级联。2011 年 2 月至 2016 年 3 月，从记录中获得了在达累斯萨拉姆穆希比利国家医院 OST 诊所登记的所有 PWID 的 HCV 血清学。2015 年，连续 HCV 血清阳性 PWID 被邀请进行临床评估，包括流行病学问卷、肝硬度测量（Fibroscan）和病毒学分析（HCV RNA 病毒载量和基因分型）。在研究期间，1350 人在 OST 诊所登记：所有人都进行了 HCV 血清学检查，其中包括 409 人（30%）阳性结果。在 HCV 血清阳性个体中，207 人（51%）为活跃就诊者，153 人（37%）接受了临床评估：141 人（92%）为男性，中位年龄为 38 岁（IQR 34-41），65 人（44%）感染 HIV；116 例患者（76%）可检测到 HCV RNA，基因型为 1a（68%）和 4a（32%）；21 例（17%）有临床显著纤维化（≥F2），6 例（5%）有肝硬化（F4）。没有人接受 HCV 治疗。在达累斯萨拉姆 OST 中心登记的 PWID 中，慢性丙型肝炎很常见，但连续性护理不足；将 HCV 诊断和治疗相结合应成为坦桑尼亚 PWID 阿片类物质替代治疗干预的一部分。
