旧金山男男性行为者和注射毒品者中 HCV 检测和治疗对 HCV 传播的影响：一项建模分析。

Impact of HCV Testing and Treatment on HCV Transmission Among Men Who Have Sex With Men and Who Inject Drugs in San Francisco: A Modelling Analysis.

机构信息

Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.

School of Public Health, University of California Berkeley, Berkeley, California, USA.

出版信息

J Infect Dis. 2023 Sep 15;228(6):662-673. doi: 10.1093/infdis/jiad169.

BACKGROUND

Men who have sex with men who ever injected drugs (ever MSM-IDU) carry a high hepatitis C virus (HCV) burden. We estimated whether current HCV testing and treatment in San Francisco can achieve the 2030 World Health Organization (WHO) HCV elimination target on HCV incidence among ever MSM-IDU.

METHODS

A dynamic HCV/HIV transmission model among MSM was calibrated to San Francisco data, including HCV antibody (15.5%, 2011) and HIV prevalence (32.8%, 2017) among ever MSM-IDU. MSM had high HCV testing (79%-86% ever tested, 2011-2019) and diagnosed MSM had high HCV treatment (65% ever treated, 2018). Following coronavirus disease 2019 (COVID-19)-related lockdowns, HCV testing and treatment decreased by 59%.

RESULTS

Among all MSM, 43% of incident HCV infections in 2022 were IDU-related. Among ever MSM-IDU in 2015, HCV incidence was 1.2/100 person-years (95% credibility interval [CrI], 0.8-1.6). Assuming COVID-19-related declines in HCV testing/treatment persist until 2030, HCV incidence among ever MSM-IDU will decrease by 84.9% (95% CrI, 72.3%-90.8%) over 2015-2030. This decline is largely attributed to HCV testing and treatment (75.8%; 95% CrI, 66.7%-89.5%). Slightly greater decreases in HCV incidence (94%-95%) are projected if COVID-19 disruptions recover by 2025 or 2022.

CONCLUSIONS

We estimate that HCV incidence will decline by >80% over 2015-2030 among ever MSM-IDU in San Francisco, achieving the WHO target.

背景

曾经注射过毒品的男男性行为者（曾经的 MSM-IDU）携带高载量的丙型肝炎病毒（HCV）。我们评估了旧金山目前对 HCV 的检测和治疗是否能实现 2030 年世界卫生组织（WHO）对曾经的 MSM-IDU 中 HCV 发病率的消除目标。

方法

对 MSM 中的 HCV/HIV 传播模型进行了校准，以适应旧金山的数据，包括曾经的 MSM-IDU 中的 HCV 抗体（15.5%，2011 年）和 HIV 流行率（32.8%，2017 年）。MSM 有很高的 HCV 检测率（79%-86%曾经接受过检测，2011-2019 年），确诊的 MSM 有很高的 HCV 治疗率（65%曾经接受过治疗，2018 年）。在 2019 年冠状病毒病（COVID-19）相关封锁之后，HCV 检测和治疗下降了 59%。

结果

在所有 MSM 中，2022 年 HCV 感染的 43%与 IDU 有关。在 2015 年的曾经的 MSM-IDU 中，HCV 发病率为 1.2/100 人年（95%可信度区间[CrI]，0.8-1.6）。假设 COVID-19 相关的 HCV 检测/治疗下降持续到 2030 年，那么 2015-2030 年期间，曾经的 MSM-IDU 中的 HCV 发病率将下降 84.9%（95% CrI，72.3%-90.8%）。这一下降主要归因于 HCV 检测和治疗（75.8%；95% CrI，66.7%-89.5%）。如果 COVID-19 的干扰在 2025 年或 2022 年恢复，预计 HCV 发病率的下降幅度会略大（94%-95%）。