Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.
Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
J Viral Hepat. 2020 Aug;27(8):770-773. doi: 10.1111/jvh.13294. Epub 2020 Apr 6.
An increasing number of countries are committing to meet the World Health Organization (WHO) targets to eliminate hepatitis C virus (HCV) as a public health threat by 2030. These include service coverage targets (90% diagnosed and 80% of diagnosed patients treated) and impact targets (80% and 65% reductions in incidence and mortality, respectively, compared to 2015 levels). Currently, a dozen countries are on track to reach 2030 WHO HCV targets. However, while striving for the WHO targets is important, it should be recognized that progress on impact targets is derived from mathematical models projecting decreases in incidence and mortality on a global scale. Despite HCV treatment access in many counties for a number of years, limited empirical data are available to evaluate progress towards elimination. In some countries, substantial incidence and mortality reductions based on reaching the WHO service coverage targets may be unachievable. For example, in countries with ageing hepatitis C-infected populations, even if they have a quality hepatitis C response, high hepatitis C-related morbidity at baseline may not be reversible even with increased HCV treatment uptake and diagnosis. Finally, WHO targets are not necessarily easily or reliably measurable. Measuring relative impact targets requires high-quality data at baseline (ie 2015) and longitudinal data to assess temporal trends. In this commentary, we propose alternative additional measures to track progress on reducing the HCV burden, offer examples where the WHO targets may not be informative or achievable, and potential practical solutions.
越来越多的国家承诺到 2030 年实现世界卫生组织（WHO）消除丙型肝炎病毒（HCV）作为公共卫生威胁的目标。这些目标包括服务覆盖目标（90%的诊断和80%的确诊患者得到治疗）和影响目标（与 2015 年相比，发病率和死亡率分别降低 80%和 65%）。目前，有十几个国家有望实现 2030 年 WHO HCV 目标。然而，尽管努力实现世卫组织的目标很重要，但应该认识到，影响目标的进展是来自于全球范围内发病率和死亡率下降的数学模型预测。尽管多年来许多国家都可以获得 HCV 治疗，但可用的评估消除进展的经验数据有限。在一些国家，即使达到了世卫组织的服务覆盖目标，也可能无法实现基于发病率和死亡率降低的实质性目标。例如，在丙型肝炎感染人群老龄化的国家，即使他们对丙型肝炎有良好的反应，高基线丙型肝炎相关发病率可能也无法逆转，即使增加丙型肝炎治疗的采用和诊断。最后，世卫组织的目标不一定是易于或可靠地衡量的。衡量相对影响目标需要高质量的基线数据（即 2015 年）和纵向数据来评估时间趋势。在这篇评论中，我们提出了替代的额外措施来跟踪减少 HCV 负担的进展，提供了世卫组织目标可能不具有信息性或不可实现的例子，并提出了潜在的实用解决方案。
