British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Liver Int. 2019 Dec;39(12):2261-2272. doi: 10.1111/liv.14227. Epub 2019 Sep 20.
Population-level monitoring of hepatitis C virus (HCV) infected people across cascades of care identifies gaps in access and engagement in care and treatment. We characterized the population-level care cascade for HCV in British Columbia (BC), Canada before and after introduction of Direct Acting Antiviral (DAA) treatment.
BC Hepatitis Testers Cohort (BC-HTC) includes 1.7 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2018 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV care cascade stages: (a) antibody diagnosed; (b) RNA tested; (c) RNA positive; (d) genotyped; (e) initiated treatment; and (f) achieved sustained virologic response (SVR).
We estimated 61 127 people were HCV antibody positive in BC in 2018 (undiagnosed: 7686, 13%; diagnosed: 53 441, 87%). Of those diagnosed, 83% (44 507) had HCV RNA testing, and of those RNA positive, 90% (28 716) were genotyped. Of those genotyped, 61% (17 441) received therapy, with 90% (15 672) reaching SVR. Individuals from older birth cohorts had lower progression to HCV RNA testing. While people who currently inject drugs had the highest proportional progression to RNA testing, this group had the lowest proportional treatment uptake.
Although gaps in HCV RNA and genotype testing after antibody diagnosis exist, the largest gap in the care cascade is treatment initiation, despite introduction of DAA treatment and removal of treatment eligibility restrictions. Further interventions are required to ensure testing and treatment is equitably accessible in BC.
通过对整个医疗照护流程中的丙型肝炎病毒 (HCV) 感染者进行人群水平监测，可以发现获得和参与照护及治疗方面存在的差距。我们描述了加拿大不列颠哥伦比亚省 (BC) 在引入直接作用抗病毒药物 (DAA) 治疗前后 HCV 的人群水平照护流程。
BC 丙型肝炎检测者队列 (BC-HTC) 包括 170 万在 1990 年至 2018 年期间在 BC 接受 HCV、HIV、乙型肝炎报告病例和活动性肺结核检测的个体，这些个体与医疗就诊、住院、癌症、处方药和死亡率数据相关联。我们定义了六个 HCV 照护流程阶段：(a) 抗体诊断；(b) RNA 检测；(c) RNA 阳性；(d) 基因分型；(e) 开始治疗；和 (f) 实现持续病毒学应答 (SVR)。
我们估计 2018 年 BC 有 61127 人 HCV 抗体阳性（未确诊：7686，13%；确诊：53441，87%）。在确诊的患者中，83%（44507 人）接受了 HCV RNA 检测，在 RNA 阳性的患者中，90%（28716 人）进行了基因分型。在基因分型的患者中，61%（17441 人）接受了治疗，其中 90%（15672 人）达到 SVR。年龄较大出生队列的患者 HCV RNA 检测进展较低。虽然目前注射毒品的人 RNA 检测比例最高，但该人群的治疗接受比例最低。
尽管在抗体诊断后 HCV RNA 和基因分型检测存在差距，但照护流程中最大的差距是治疗开始，尽管引入了 DAA 治疗并取消了治疗资格限制。在 BC 还需要进一步的干预措施来确保检测和治疗公平地普及。
