School of Public Health, Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, California, USA.
Facente Consulting, Richmond, California, USA.
Clin Infect Dis. 2021 Sep 15;73(6):e1290-e1295. doi: 10.1093/cid/ciab261.
To achieve elimination of hepatitis C virus (HCV) infection, limited resources can be best allocated through estimation of "care cascades" among groups disproportionately affected. In San Francisco and elsewhere, these groups include young (age ≤ 30 years) people who inject drugs (YPWID), men who have sex with men who inject drugs (MSM-IDU), and low-income trans women.
We developed cross-sectional HCV care cascades for YPWID, MSM-IDU, and trans women using diverse data sources. Population sizes were estimated using an inverse variance-weighted average of estimates from the peer-reviewed literature between 2013 and 2019. Proportions of past/current HCV infection, diagnosed infection, treatment initiation, and evidence of cure (sustained virologic response at 12 weeks posttreatment) were estimated from the literature using data from 7 programs and studies in San Francisco between 2015 and 2020.
The estimated number of YPWID in San Francisco was 3748; 58.4% had past/current HCV infection, of whom 66.4% were diagnosed with current infection, 9.1% had initiated treatment, and 50% had confirmed cure. The corresponding figures for the 8135 estimated MSM-IDU were: 29.4% with past/current HCV infection, 70.3% diagnosed with current infection, 28.4% initiated treatment, and 38.9% with confirmed cure. For the estimated 951 low-income trans women, 24.8% had past/current HCV infection, 68.9% were diagnosed with current infection, 56.5% initiated treatment, and 75.5% had confirmed cure.
In all 3 populations, diagnosis rates were relatively high; however, attention is needed to urgently increase treatment initiation in all groups, with a particular unmet need among YPWID.
为了实现消除丙型肝炎病毒（HCV）感染的目标，可以通过估计受影响程度不同的人群的“护理级联”来合理分配有限的资源。在旧金山和其他地方，这些人群包括年轻（≤30 岁）的静脉注射吸毒者（YPWID）、男男性行为者静脉注射吸毒者（MSM-IDU）和低收入跨性别女性。
我们使用多种数据源为 YPWID、MSM-IDU 和跨性别女性开发了横断面 HCV 护理级联。人口规模是使用 2013 年至 2019 年同行评议文献中估计值的倒数方差加权平均值来估计的。过去/当前 HCV 感染、诊断感染、治疗开始和治愈证据（治疗后 12 周持续病毒学应答）的比例是根据 2015 年至 2020 年在旧金山的 7 个项目和研究中的文献数据从文献中估计的。
旧金山估计的 YPWID 人数为 3748 人；58.4%有过去/当前 HCV 感染，其中 66.4%诊断为当前感染，9.1%接受了治疗，50%确认治愈。估计的 8135 名 MSM-IDU 对应的数字分别为：29.4%有过去/当前 HCV 感染，70.3%诊断为当前感染，28.4%接受了治疗，38.9%确认治愈。对于估计的 951 名低收入跨性别女性，24.8%有过去/当前 HCV 感染，68.9%诊断为当前感染，56.5%接受了治疗，75.5%确认治愈。
在所有 3 个人群中，诊断率相对较高；然而，需要紧急关注所有群体中治疗启动率的提高，YPWID 群体的需求尤其未得到满足。
