Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Microbiol Immunol Infect. 2023 Jun;56(3):586-597. doi: 10.1016/j.jmii.2023.04.012. Epub 2023 Apr 29.
Gaps in linkage-to-care remain the barriers toward hepatitis C virus (HCV) elimination in the directly-acting-antivirals (DAA) era, especially during SARS Co-V2 pandemics. We established an outreach project to target HCV micro-elimination in HCV-hyperendemic villages.
The COMPACT provided "door-by-door" screening by an "outreach HCV-checkpoint team" and an "outreach HCV-care team" for HCV diagnosis, assessment and DAA therapy in Chidong/Chikan villages between 2019 and 2021. Participants from neighboring villages served as Control group.
A total of 5731 adult residents participated in the project. Anti-HCV prevalence rate was 24.0% (886/3684) in Target Group and 9.5% (194/2047) in Control group (P < 0.001). The HCV-viremic rates among anti-HCV-positive subjects were 42.7% and 41.2%, respectively, in Target and Control groups. After COMPACT engagement, 80.4% (304/378) HCV-viremic subjects in the Target group were successfully linked-to-care, and Control group (70% (56/80), P = 0.039). The rates of link-to-treatment and SVR12 were comparable between Target (100% and 97.4%, respectively) and Control (100% and 96.4%) groups. The community effectiveness was 76.4% in the COMPACT campaign, significantly higher in Target group than in Control group (78.3% versus 67.5%, P = 0.039). The community effectiveness decreased significantly during SARS Co-V2 pandemic in Control group (from 81% to 31.8%, P < 0.001), but not in Target group (80.3% vs. 71.6%, P = 0.104).
The outreach door-by-door screen strategy with decentralized onsite treatment programs greatly improved HCV care cascade in HCV-hyperendemic areas, a model for HCV elimination in high-risk marginalized communities in SARS Co-V2 pandemic.
在直接作用抗病毒药物（DAA）时代，连接到护理的差距仍然是丙型肝炎病毒（HCV）消除的障碍，特别是在 SARS Co-V2 大流行期间。我们建立了一个外展项目，旨在针对 HCV 高发村的 HCV 微量消除。
2019 年至 2021 年期间，COMPACT 通过“外展 HCV 检查站小组”和“外展 HCV 护理小组”为赤东/赤坎村的 HCV 诊断、评估和 DAA 治疗提供了“逐户”筛查。来自邻近村庄的参与者作为对照组。
共有 5731 名成年居民参加了该项目。目标组抗 HCV 流行率为 24.0%（886/3684），对照组为 9.5%（194/2047）（P<0.001）。抗 HCV 阳性者中的 HCV 病毒血症率分别为目标组和对照组的 42.7%和 41.2%。在 COMPACT 参与后，目标组 80.4%（304/378）的 HCV 病毒血症患者成功与护理联系，对照组为 70%（56/80）（P=0.039）。目标组和对照组的联系治疗和 SVR12 率相似（分别为 100%和 97.4%）。COMPACT 活动的社区有效性为 76.4%，目标组明显高于对照组（78.3%对 67.5%，P=0.039）。对照组在 SARS Co-V2 大流行期间的社区有效性显著下降（从 81%降至 31.8%，P<0.001），而目标组则没有（80.3%对 71.6%，P=0.104）。
采用分散式现场治疗方案的外展逐户筛查策略大大改善了 HCV 高发地区的 HCV 护理级联，为 SARS Co-V2 大流行期间高危边缘社区消除 HCV 提供了一种模式。
