Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.
J Viral Hepat. 2022 Oct;29(10):868-878. doi: 10.1111/jvh.13727. Epub 2022 Jul 2.
The majority of Australia's hepatitis B virus (HBV) burden is borne by culturally and linguistically diverse (CALD) populations, and antiviral treatment is the mainstay of intervention. Using modelling, we estimated the impact of targeted antiviral treatment scale-up and changes in migration on HBV-related mortality and HBV elimination in CALD populations in Australia. We fitted a deterministic mathematical model based on the natural history of HBV and the Australian migration effect in four CALD population groups according to country of birth. We used three antiviral treatment scale-up scenarios: baseline (9.3% coverage); intermediate (coverage of 80% of patients eligible for antiviral therapy by 2030); and optimistic (coverage of 20% of all patients living with HBV by 2022). Our model predicted that if the baseline treatment is followed between 2015 and 2030, the number of chronic HBV cases and HBV-related mortality will increase. Following the optimistic scale-up, the number of new HBV cases could be reduced by 78%, 73%, 74% and 83% in people born in Asia-Pacific, Europe, Africa and the Middle East, and Americas, respectively, between 2015 and 2030. An optimistic treatment scale-up could result in a 19.2%-24.5% reduction in HBV-related mortality and a 15%-25% reduction in HCC-related mortality in CALD populations between 2015 and 2030. In conclusion, our findings highlight that targeted antiviral treatment for CALD populations provides significant health system benefits by reducing HBV-related complications from cirrhosis and HCC. Expanded antiviral treatment programmes focusing on high-prevalence CALD populations may be an effective strategy to reduce HBV-related morbidity and mortality.
大多数澳大利亚乙型肝炎病毒（HBV）负担由文化和语言多样化（CALD）人群承担，抗病毒治疗是干预的主要手段。我们通过建模估计了靶向抗病毒治疗扩大规模和移民变化对澳大利亚 CALD 人群中 HBV 相关死亡率和 HBV 消除的影响。我们根据出生地将四个 CALD 人群组拟合了一个基于 HBV 自然史和澳大利亚移民效应的确定性数学模型。我们使用了三种抗病毒治疗扩大规模方案：基线（9.3%的覆盖率）；中期（到 2030 年，将 80%有资格接受抗病毒治疗的患者纳入治疗范围）；乐观（到 2022 年，将 20%的所有 HBV 患者纳入治疗范围）。我们的模型预测，如果在 2015 年至 2030 年期间采用基线治疗方案，慢性 HBV 病例数和 HBV 相关死亡率将会增加。在乐观的治疗方案下，到 2030 年，在亚太地区、欧洲、非洲和中东以及美洲出生的人群中，新的 HBV 病例数量分别可以减少 78%、73%、74%和 83%。在 2015 年至 2030 年期间，乐观的治疗方案可使 CALD 人群的 HBV 相关死亡率降低 19.2%-24.5%，HCC 相关死亡率降低 15%-25%。总之，我们的研究结果表明，针对 CALD 人群的靶向抗病毒治疗通过减少肝硬化和 HCC 相关的 HBV 并发症，为卫生系统带来了显著的效益。针对高流行 CALD 人群的扩大抗病毒治疗方案可能是降低 HBV 相关发病率和死亡率的有效策略。
