巴西巴西利亚>40 岁人群中的丙型肝炎筛查、诊断和护理级联。
Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil.
机构信息
Gastroenterology Unit, Instituto Hospital de Base, Brasilia, Federal District, 70322-000, Brazil.
Gilead Sciences Farmacêutica do Brasil Ltd. and Liver Center at UFMG, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 04711-130, Brazil.
出版信息
BMC Infect Dis. 2020 Feb 10;20(1):114. doi: 10.1186/s12879-020-4809-2.
BACKGROUND
Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals.
METHODS
This cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography.
RESULTS
The prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication.
CONCLUSIONS
The prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis.
TRIAL REGISTRATION
Research Ethics Committee of the Faculty of Health Sciences of the University of Brasília - UNB (CAAE number 77818317.2.0000.0030) and by the Ethics Committee of the Health Science Teaching and Research Foundation - FEPECS/SES/DF (CAAE number 77818317.2.3001.5553).
背景
识别丙型肝炎病毒（HCV）感染者并加强诊疗流程，对于消除 HCV 感染至关重要。本研究旨在估计巴西首都巴西利亚 HCV 阳性抗血清的流行率，并评估 HCV 阳性个体的诊疗流程效率。
方法
本横断面研究分析了 2018 年 6 月至 2019 年 6 月间年龄>40 岁的个体进行的 57697 例 HCV 快速筛查检测。对 HCV 阳性患者进行接触并安排进行 HCV RNA 病毒检测、基因分型和瞬时弹性成像检查。
结果
抗血清阳性率为 0.27%。在 161 例抗 HCV 血清阳性患者中，有 124 例（77%）被联系，109 例（67.7%）进行了 HCV RNA 病毒载量检测，69 例（42.8%）检测结果阳性。1 型（75%）是最常见的基因型。在 65 例（94.2%）接受瞬时弹性成像检查的患者中，有 30 例（46.2%）存在晚期纤维化。此外，在 161 例患者中，有 55 例（34.1%）被转介接受治疗，但只有 39 例（24.2%）接受治疗，其中 36 例（22.4%）出现持续病毒学应答。研究结束时，仍有 16 例患者在等待接受药物治疗。
结论
巴西利亚 HCV 阳性患者的流行率较低，这些患者的诊疗流程存在显著差距，未达到消除 HCV 感染的目标。本研究为消除 HCV 感染开辟了新途径，并表明与临床实验室合作进行抗 HCV 检测是提高 HCV 诊断率的有效策略。
试验注册
巴西利亚大学健康科学学院研究伦理委员会（CAAE 编号 77818317.2.0000.0030）和卫生科学教学与研究基金会伦理委员会（CAAE 编号 77818317.2.3001.5553）。
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