Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
BMJ Glob Health. 2020 Jun;5(6). doi: 10.1136/bmjgh-2020-002306.
China has the highest number of hepatitis B and C cases globally. Despite remarkable achievements, China faces daunting challenges in achieving international targets for hepatitis elimination. As part of a large-scale project assessing China's progress in achieving health-related Sustainable Development Goals using quantitative, qualitative data and mathematical modelling, this paper summarises the achievements, gaps and challenges, and proposes options for actions for hepatitis B and C control. China has made substantial progress in controlling chronic viral hepatitis. The four most successful strategies have been: (1) hepatitis B virus childhood immunisation; (2) prevention of mother-to-child transmission; (3) full coverage of nucleic acid amplification testing in blood stations and (4) effective financing strategies to support treatment. However, the total number of deaths due to hepatitis B and C is estimated to increase from 434 724 in 2017 to 527 829 in 2030 if there is no implementation of tailored interventions. Many health system barriers, including a fragmented governance system, insufficient funding, inadequate service coverage, unstandardised treatment and flawed information systems, have compromised the effective control of hepatitis B and C in China. We suggest five strategic priority actions to help eliminate hepatitis B and C in China: (1) restructure the viral hepatitis control governance system; (2) optimise health resource allocation and improve funding efficiency; (3) improve access to and the quality of the health benefits package, especially for high-risk groups; (4) strengthen information systems to obtain high-quality hepatitis epidemiological data; (5) increase investment in viral hepatitis research and development.
中国是全球乙肝和丙肝病例最多的国家。尽管取得了显著成就，但中国在实现消除肝炎国际目标方面仍面临艰巨挑战。作为使用定量、定性数据和数学模型评估中国在实现与健康相关的可持续发展目标方面进展情况的大型项目的一部分，本文总结了乙肝和丙肝控制的成就、差距和挑战，并提出了行动方案。中国在控制慢性病毒性肝炎方面取得了重大进展。四项最成功的策略包括：（1）乙肝病毒儿童免疫接种；（2）预防母婴传播；（3）血站全面开展核酸扩增检测；（4）制定有效的融资策略，以支持治疗。然而，如果不实施有针对性的干预措施，预计 2017 年至 2030 年期间，乙肝和丙肝导致的死亡总数将从 434724 例增加到 527829 例。许多卫生系统障碍，包括分散的治理体系、资金不足、服务覆盖范围不足、治疗不规范和信息系统不完善，都影响了中国乙肝和丙肝的有效控制。我们建议采取五项战略优先行动，以帮助中国消除乙肝和丙肝：（1）重构病毒性肝炎控制治理体系；（2）优化卫生资源配置，提高资金使用效率；（3）改善卫生福利包的可及性和质量，特别是针对高风险群体；（4）加强信息系统，获取高质量的肝炎流行数据；（5）增加对病毒性肝炎研发的投资。
