Wilkinson Anna Lee, van Santen Daniela K, Traeger Michael W, Sacks-Davis Rachel, Asselin Jason, Scott Nick, Harney Brendan L, Doyle Joseph S, El-Hayek Carol, Howell Jessica, Bramwell Fran, McManus Hamish, Donovan Basil, Stoové Mark, Hellard Margaret, Pedrana Alisa
Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
Int J Drug Policy. 2022 May;103:103655. doi: 10.1016/j.drugpo.2022.103655. Epub 2022 Mar 26.
Monitoring trends in hepatitis C virus (HCV) incidence is critical for evaluating strategies aimed at eliminating HCV as a public health threat. We estimate HCV incidence and assess trends in incidence over time among primary care patients.
Data were routinely extracted, linked electronic medical records from 12 primary care health services. Patients included were aged ≥16 years, tested HCV antibody negative on their first test recorded and had at least one subsequent HCV antibody or RNA test (January 2009-December 2020). HCV incident infections were defined as a positive HCV antibody or RNA test. A generalised linear model assessed the association between HCV incidence and calendar year.
In total, 6711 patients contributed 17,098 HCV test records, 210 incident HCV infections and 19,566 person-years; incidence was 1.1 per 100 person-years (95% confidence interval (CI): 0.9 to 1.2). Among 559 (8.2%) patients ever prescribed opioid-related pharmacotherapy (ORP) during the observation period, 135 infections occurred during 2,082 person-years (incidence rate of 6.5 per 100 person-years (95% CI: 5.4 to 7.7)). HCV incidence declined 2009-2020 overall (incidence rate ratio per calendar year 0.8 (95% CI: 0.8 to 0.9) and among patients ever prescribed ORT (incidence rate ratio per calendar year 0.9, 95% CI: 0.75 to 1.0).
HCV incidence declined among patients at primary care health services including among patients ever prescribed ORP and during the period following increased access to DAA therapy.
监测丙型肝炎病毒（HCV）发病率趋势对于评估旨在消除HCV这一公共卫生威胁的策略至关重要。我们估计HCV发病率，并评估初级保健患者中发病率随时间的变化趋势。
数据常规提取自12家初级保健卫生服务机构的关联电子病历。纳入的患者年龄≥16岁，首次记录的检测HCV抗体为阴性，且至少有一次后续的HCV抗体或RNA检测（2009年1月至2020年12月）。HCV新发感染定义为HCV抗体或RNA检测呈阳性。采用广义线性模型评估HCV发病率与日历年之间的关联。
总共6711名患者提供了17098份HCV检测记录，210例HCV新发感染，19566人年；发病率为每100人年1.1例（95%置信区间（CI）：0.9至1.2）。在观察期内曾接受阿片类药物相关药物治疗（ORP）的559名（8.2%）患者中，2082人年期间发生了135例感染（发病率为每100人年6.5例（95%CI：5.4至7.7））。2009 - 2020年期间总体HCV发病率下降（日历年发病率比为0.8（95%CI：0.8至0.9）），在曾接受ORT治疗的患者中（日历年发病率比为0.9，95%CI：0.75至1.0）。
初级保健卫生服务机构患者中的HCV发病率下降，包括曾接受ORP治疗的患者以及在直接抗病毒药物（DAA）治疗可及性增加后的时期。
