MMWR Morb Mortal Wkly Rep. 2023 Jun 2;72(22):597-600. doi: 10.15585/mmwr.mm7222a2.
Approximately 2.4 million persons in the United States have hepatitis C virus (HCV) infection, and 66,700 acute HCV infection cases were estimated for 2020 (1,2). American Indian or Alaska Native (AI/AN) persons are disproportionately affected by HCV infection and experienced the highest rates of acute HCV infection (2.1 cases per 100,000 persons) and HCV-associated mortality (10.17 per 100,000 persons) in the United States during 2020 (1). During 2015, Cherokee Nation Health Services (CNHS) in Oklahoma implemented an HCV elimination program, which includes universal HCV screening, primary HCV workforce expansion, and harm reduction services (3). To assess progress 5 years after program initiation, CNHS analyzed deidentified health record data. During November 1, 2015-October 31, 2020, a total of 1,423 persons received a diagnosis of HCV infection. Among these persons, 1,227 (86.2%) were linked to HCV care, and 871 (61.2%) initiated HCV treatment; 702 (49.3%) returned for their 12-week post treatment completion visit, at which time 698 (49.1%) had achieved laboratory-confirmed sustained virologic response (SVR), defined as undetectable HCV RNA at ≥12 weeks after completion of treatment (SVR12). Although CNHS has linked the majority of persons diagnosed with HCV infection to care, and those who returned for the SVR12 visit had high cure rates (99.4%), treatment initiation was lower than expected. Future activities should prioritize addressing gaps in treatment initiation after linkage to care and confirmation of hepatitis C cure with SVR12 testing.
美国约有 240 万人感染丙型肝炎病毒 (HCV)，据估计，2020 年有 66700 例急性 HCV 感染病例 (1,2)。美国印第安人或阿拉斯加原住民 (AI/AN) 人群受 HCV 感染的影响不成比例，在 2020 年，他们的急性 HCV 感染率 (每 10 万人中有 2.1 例) 和 HCV 相关死亡率 (每 10 万人中有 10.17 例) 均为全美最高 (1)。2015 年，俄克拉荷马州的切罗基族卫生服务中心 (CNHS) 实施了 HCV 消除计划，该计划包括普遍 HCV 筛查、初级 HCV 劳动力扩充和减少伤害服务 (3)。为了评估该计划启动 5 年后的进展情况，CNHS 分析了去标识化的健康记录数据。在 2015 年 11 月 1 日至 2020 年 10 月 31 日期间，共有 1423 人被诊断为 HCV 感染。在这些人中，有 1227 人 (86.2%) 与 HCV 护理相关联，有 871 人 (61.2%) 开始 HCV 治疗；有 702 人 (49.3%) 返回进行治疗完成后 12 周的随访，此时有 698 人 (49.1%) 达到实验室确认的持续病毒学应答 (SVR)，定义为治疗完成后至少 12 周时 HCV RNA 不可检测 (SVR12)。尽管 CNHS 已经将大多数被诊断为 HCV 感染的人联系到护理中心，但那些返回进行 SVR12 随访的人有很高的治愈率 (99.4%)，但治疗开始率低于预期。未来的活动应优先解决治疗开始率低的问题，以及通过 SVR12 检测确认 HCV 治愈的问题。
