Chan Po-Lin, Le Linh-Vi, Ishikawa Naoko, Easterbrook Philippa
World Health Organization Office for the Western Pacific, Manila, Philippines.
World Health Organization, Geneva, Switzerland.
Glob Health Med. 2021 Oct 31;3(5):253-261. doi: 10.35772/ghm.2021.01065.
Chronic hepatitis C (HCV) infection is a major global public health threat and in 2019 there were an estimated 58 million infected globally and 290,000 deaths. Elimination of viral hepatitis B/C as a public health threat by 2030 is defined as a 90% incidence reduction and a 65% mortality reduction. The Western Pacific region is one of the most affected regions with 10 million people living with HCV, one-fifth of the global burden. We review progress towards HCV elimination in the Western Pacific region since 2015. Key developments in the region, which comprises of 37 high-and-middle-income countries, include the following: 20 countries have national hepatitis action plans, 19 have conducted recent disease burden and investment cases, 10 have scaled-up hepatitis services at primary health care level, and in 11 countries, domestic financing including social health insurance support DAA costs. We highlight six countries' experience in navigating the path towards HCV elimination: Cambodia, China, Malaysia, Mongolia, Philippines, and Viet Nam. Future initiatives to accelerate elimination are expanding access to community-based testing using HCV point-of-care tests among at-risk and general populations; adopting decentralized and integrated HCV one-stop services at harm reduction sites, detention settings and primary care; expanding treatment to include children and adolescents; address stigma and discrimination; and ensuring sustainable financing through domestic resources to scale-up testing, treatment and prevention. The COVID-19 pandemic has a significant impact on hepatitis response across the region on community and facility-based testing, treatment initiation, monitoring and cancer screening, which is projected to delay elimination goals.
慢性丙型肝炎病毒(HCV)感染是全球主要的公共卫生威胁,2019年全球估计有5800万人感染,29万人死亡。到2030年消除病毒性乙型/丙型肝炎这一公共卫生威胁的定义是发病率降低90%,死亡率降低65%。西太平洋地区是受影响最严重的地区之一,有1000万人感染HCV,占全球负担的五分之一。我们回顾了自2015年以来西太平洋地区在消除HCV方面取得的进展。该地区由37个中高收入国家组成,主要进展包括:20个国家有国家肝炎行动计划,19个国家最近开展了疾病负担和投资案例研究,10个国家在初级卫生保健层面扩大了肝炎服务,11个国家的国内融资包括社会医疗保险支持直接抗病毒药物(DAA)费用。我们重点介绍了六个国家在迈向消除HCV道路上的经验:柬埔寨、中国、马来西亚、蒙古、菲律宾和越南。未来加速消除的举措包括在高危人群和普通人群中扩大基于社区的检测,使用HCV即时检测;在减少伤害场所、拘留场所和初级保健机构采用分散式和综合性HCV一站式服务;将治疗扩大到儿童和青少年;消除耻辱和歧视;并通过国内资源确保可持续融资,以扩大检测、治疗和预防规模。2019冠状病毒病疫情对该地区肝炎应对工作在社区和机构检测、治疗启动、监测和癌症筛查方面产生了重大影响,预计将推迟消除目标。