Malik Farihah, Bailey Heather, Chan Polin, Collins Intira Jeannie, Mozalevskis Antons, Thorne Claire, Easterbrook Philippa
UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
UCL Institute for Global Health, University College London, London, UK.
JHEP Rep. 2021 Jan 15;3(2):100227. doi: 10.1016/j.jhepr.2021.100227. eCollection 2021 Apr.
BACKGROUND & AIMS: It is estimated that 3.26 million children and adolescents worldwide have chronic HCV infection. To date, the global response has focused on the adult population, but direct-acting antiviral (DAA) regimens are now approved for children aged ≥3 years. This global review describes the current status of policies on HCV testing and treatment in children, adolescents, and pregnant women in WHO Member States.
We identified national strategic plans and/or clinical practice guidelines (CPGs) for HCV infection from a World Health Organization (WHO) database of national policies from Member States as of August 2019. A standardised was used to abstract data on polices or recommendations on testing and treatment in children, adolescents and pregnant women. Analysis was stratified according to the country-income status and results were validated through WHO regional focal points through August 2020.
National HCV policies were available for 122 of the 194 WHO Member States. Of these, the majority (n = 71/122, 58%) contained no policy recommendations for either testing or treatment in children or adolescents. Of the 51 countries with policies, 24 had specific policies for both testing and treatment, and were mainly from the European region; 18 countries for HCV testing only (12 from high- or upper-middle income); and 9 countries for treatment only (7 high- or upper-middle income). Twenty-one countries provided specific treatment recommendations: 13 recommended DAA-based regimens for adolescents ≥12 years and 6 still recommended interferon/ribavirin-based regimens.
There are significant gaps in policies for HCV-infected children and adolescents. Updated guidance on testing and treatment with newly approved DAA regimens for younger age groups is needed, especially in most affected countries.
To date, the predominant focus of the global response towards elimination of hepatitis C has been on the testing and treatment of adults. Much less attention has been paid to testing and treatment among children and adolescents, although in 2018 an estimated 3.26 million were infected with HCV. Our review shows that many countries have no national guidance on HCV testing and treatment in children and adolescents. It highlights the urgent need for advocacy and updated policies and guidelines specific for children and adolescents.
据估计，全球有326万儿童和青少年患有慢性丙型肝炎病毒（HCV）感染。迄今为止，全球应对措施主要集中在成人人群，但直接抗病毒药物（DAA）方案现已被批准用于3岁及以上儿童。本全球综述描述了世卫组织成员国中儿童、青少年和孕妇HCV检测与治疗政策的现状。
我们从世界卫生组织（WHO）截至2019年8月的成员国国家政策数据库中，识别出有关HCV感染的国家战略计划和/或临床实践指南（CPG）。使用标准化方法提取有关儿童、青少年和孕妇检测与治疗的政策或建议的数据。分析按国家收入状况分层，结果截至2020年8月通过世卫组织区域协调人进行了验证。
194个世卫组织成员国中的122个有国家HCV政策。其中，大多数（n = 71/122，58%）在儿童或青少年检测或治疗方面没有政策建议。在有政策的51个国家中，24个国家对检测和治疗都有具体政策，且主要来自欧洲区域；18个国家只有HCV检测政策（12个来自高收入或中高收入国家）；9个国家只有治疗政策（7个来自高收入或中高收入国家）。21个国家提供了具体的治疗建议：13个国家推荐为12岁及以上青少年使用基于DAA的方案，6个国家仍推荐使用基于干扰素/利巴韦林的方案。
HCV感染儿童和青少年的政策存在重大差距。需要针对较年轻年龄组新批准的DAA方案进行检测和治疗的更新指南，特别是在受影响最严重的国家。
迄今为止，全球消除丙型肝炎的应对措施主要集中在成人检测和治疗上。尽管2018年估计有326万儿童和青少年感染HCV，但对他们的检测和治疗关注较少。我们的综述表明，许多国家在儿童和青少年HCV检测和治疗方面没有国家指南。这凸显了迫切需要进行宣传，并制定针对儿童和青少年的更新政策和指南。
