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加速消除病毒性肝炎:柳叶刀胃肠病学和肝脏病学委员会报告

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission.

机构信息

Division of Infectious Diseases, Imperial College London, London, UK.

Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland.

出版信息

Lancet Gastroenterol Hepatol. 2019 Feb;4(2):135-184. doi: 10.1016/S2468-1253(18)30270-X.

Abstract

Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.

摘要

病毒性肝炎是一项重大的公共卫生威胁,也是全球主要的死亡原因之一。病毒性肝炎的年死亡率与艾滋病病毒和结核病等其他主要传染病相似。高度有效的预防措施和治疗方法使全球消除病毒性肝炎成为一个现实目标,得到了所有世卫组织成员国的认可。雄心勃勃的目标要求到 2030 年,全球因肝炎相关疾病导致的死亡率降低 65%,新感染率降低 90%。本委员会汇集了广泛的专业知识,评估当前的全球形势,并确定在全球、区域和国家各级需要优先采取的措施,以加快进展。我们确定了 20 个负担沉重的国家,这些国家占全球病毒性肝炎负担的 75%以上。主要建议包括更加关注各国在消除方面的进展,如果需要,通过创新融资措施提供支持,以确保到 2020 年消除规划得到充分供资。除了进一步采取措施增加疫苗和治疗的可及性外,还需要更加关注负担得起的高质量诊断的可及性,以确保检测达到实现消除目标所需的水平。需要简化、分散的护理模式,取消对专业处方的要求,以满足有需要的人群,并持续努力解决污名化和歧视问题。我们确定了世界许多国家在取得进展方面的关键范例,表明持续和协调的努力可以成功实现世卫组织消除目标。

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