Swe Thein Min, Johnson Derek C, Mar Htay Thet, Thit Phone, Homan Tobias, Chu Cherry May, Mon Phyu Ei, Thwe Thin Thin, Soe Kyi Pyar, Ei Win Le Shwe Sin, Tun Nyan Lynn, Lwin Kyaw Zay, Karakozian Hayk, Aung Khin Sanda, Nguyen Aude, Ciglenecki Iza, Tamayo Natalia, Loarec Anne
Medecins Sans Frontieres Dawei Myanmar.
Medecins Sans Frontieres Yangon Myanmar.
Health Sci Rep. 2023 Feb 17;6(2):e1119. doi: 10.1002/hsr2.1119. eCollection 2023 Feb.
In Myanmar, public sector treatment programs for hepatitis C virus (HCV) infection were nonexistent until June 2017. WHO highlights the importance of simplification of HCV service delivery through task-shifting among health workers and decentralization to the primary health care level. Between November 2016 and November 2017, a study was conducted to describe the epidemiological data and real-world outcomes of treating HIV/HCV coinfected patients with generic direct acting antiviral (DAA) based regimens in the three HIV clinics run by nonspecialist medical doctors in Myanmar.
HCV co-infection among people living with HIV (PLHIV) from two clinics in Yangon city and one clinic in Dawei city was screened by rapid diagnostic tests and confirmed by testing for viral RNA. Nonspecialist medical doctors prescribed sofosbuvir and daclatasvir based regimens (with or without ribavirin) for 12 or 24 weeks based on the HCV genotype and liver fibrosis status. Sustained virologic response at 12 weeks after treatment (SVR12) was assessed to determine cure.
About 6.5% (1417/21,777) of PLHIV were co-infected with HCV. Of 864 patients enrolled in the study, 50.8% reported history of substance use, 27% history of invasive medical procedures and 25.6% history of incarceration. Data on treatment outcomes were collected from 267 patients of which 257 (96.3%) achieved SVR12, 7 (2.6%) failed treatment, 2 (0.7%) died and 1 (0.4%) became loss to follow-up.
The study results support the integration of hepatitis C diagnosis and treatment with DAA-based regimens into existing HIV clinics run by nonspecialist medical doctors in a resource-limited setting. Epidemiological data on HIV/HCV co-infection call for comprehensive HCV care services among key populations like drug users and prisoners in Yangon and Dawei.
在缅甸，直到2017年6月才出现针对丙型肝炎病毒（HCV）感染的公共部门治疗项目。世界卫生组织强调通过医护人员之间的任务转移以及权力下放到初级卫生保健层面来简化HCV服务提供的重要性。在2016年11月至2017年11月期间，开展了一项研究，以描述在缅甸由非专科医生运营的三家HIV诊所中，使用基于通用直接抗病毒药物（DAA）的方案治疗HIV/HCV合并感染患者的流行病学数据和实际治疗效果。
通过快速诊断检测对仰光市两家诊所和土瓦市一家诊所的HIV感染者（PLHIV）中的HCV合并感染情况进行筛查，并通过病毒RNA检测进行确诊。非专科医生根据HCV基因型和肝纤维化状况，开具基于索磷布韦和达卡他韦的方案（含或不含利巴韦林），疗程为12周或24周。评估治疗12周后的持续病毒学应答（SVR12）以确定是否治愈。
约6.5%（1417/21777）的PLHIV合并感染HCV。在纳入研究的864例患者中，50.8%报告有药物使用史，27%有侵入性医疗操作史，25.6%有监禁史。从267例患者中收集了治疗结果数据，其中257例（96.3%）实现了SVR12，7例（2.6%）治疗失败，2例（0.7%）死亡，1例（0.4%）失访。
研究结果支持在资源有限的环境中，将基于DAA方案的丙型肝炎诊断和治疗纳入由非专科医生运营的现有HIV诊所。HIV/HCV合并感染的流行病学数据表明，仰光和土瓦的吸毒者和囚犯等重点人群需要全面的HCV护理服务。
