Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2022 Jul;38(7):694-702. doi: 10.1002/kjm2.12552. Epub 2022 Apr 29.
Understanding the barriers and tackling the hurdles of hepatitis C virus (HCV) care cascades is key to HCV elimination. The current study aimed to investigate the rates of disease awareness, link-to-care, and treatment uptake of HCV in a hyperendemic area in Taiwan. Tzukuan residents from 2000 to 2018 were invited to participate in the questionnaire-based interviews for HCV. The rates of disease awareness, accessibility, and anti-HCV therapy were evaluated in anti-HCV-seropositive participants. Among 10,348 residents, 1789 (17.3%) were anti-HCV seropositive. Of these 1789 anti-HCV-seropositive participants, data of 594 participants from questionnaire-based interviews in 2005-2018 were analyzed for HCV care cascades. Overall, 24.9% of anti-HCV-seropositive HCV participants had disease awareness, 53.9% of aware participants had accessibility, and 79.8% of assessed participants had received HCV treatment, with a community effectiveness of 10.7%. HCV prevalence decreased over time, from 21.2% in the early cohort to 9.3% in the recent cohort. Disease awareness increased over time, from 15.6% to 41.7%, with the community effectiveness increasing from 1.3% to 28.8%. Lower education levels and normal liver biochemistry were associated with a lower rate of disease awareness. Notably, 68% of participants with abnormal liver biochemistry and 69% of those with advanced fibrosis (FIB-4 > 3.25) were unaware of their HCV disease. We demonstrated huge gaps in disease awareness, link-to-care, and treatment uptake in the HCV care cascade in an HCV-hyperendemic area, even in the initial era of direct-acting antiviral agents. There is an urgent need to overcome these hurdles to achieve HCV elimination.
了解丙型肝炎病毒 (HCV) 护理级联的障碍并克服这些障碍是消除 HCV 的关键。本研究旨在调查台湾高度流行地区 HCV 的疾病知晓率、连接到护理和治疗接受率。邀请 2000 年至 2018 年的竹堑居民参加基于问卷调查的 HCV 访谈。在抗 HCV 阳性参与者中评估疾病知晓率、可及性和抗 HCV 治疗率。在 10348 名居民中,1789 人(17.3%)抗 HCV 血清阳性。在这 1789 名抗 HCV 血清阳性参与者中,分析了 2005-2018 年基于问卷调查的访谈中 594 名参与者的数据,以了解 HCV 护理级联。总体而言,24.9%的抗 HCV 血清阳性 HCV 参与者有疾病意识,53.9%的有疾病意识的参与者有可及性,79.8%的评估参与者接受了 HCV 治疗,社区有效率为 10.7%。HCV 患病率随时间降低,从早期队列的 21.2%降至近期队列的 9.3%。疾病知晓率随时间增加,从 15.6%增加到 41.7%,社区有效率从 1.3%增加到 28.8%。较低的教育水平和正常的肝功能与较低的疾病知晓率相关。值得注意的是,68%肝功能异常和 69%纤维化程度较高(FIB-4>3.25)的参与者不知道自己患有 HCV 疾病。我们在 HCV 高度流行地区的 HCV 护理级联中发现了巨大的疾病知晓、连接到护理和治疗接受率差距,即使在直接作用抗病毒药物的初始时代也是如此。迫切需要克服这些障碍以实现 HCV 消除。