中东和北非地区丙型肝炎病毒治疗即预防：一项模型研究
Treatment as prevention for hepatitis C virus in the Middle East and North Africa: a modeling study.
作者信息
Ayoub Houssein H, Mahmud Sarwat, Chemaitelly Hiam, Abu-Raddad Laith J
机构信息
Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar.
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
出版信息
Front Public Health. 2023 Jul 13;11:1187786. doi: 10.3389/fpubh.2023.1187786. eCollection 2023.
BACKGROUND
Direct-acting antivirals opened an opportunity for eliminating hepatitis C virus (HCV) infection in the Middle East and North Africa (MENA), the region most affected by HCV infection. Impact of HCV treatment as prevention (HCV-TasP) was investigated in 19 MENA countries.
METHODS
An age-structured mathematical model was used to assess program impact using epidemiologic and programming measures. The model was fitted to a database of systematically gathered HCV antibody prevalence data. Two main scenarios were investigated for the treatment roll-out to achieve (i) 80% reduction in HCV incidence by 2030, and (ii) incidence rate < 1 per 100,000 person-years by 2030.
RESULTS
In the target-80%-incidence-reduction scenario, number of treatments administrated by 2030 ranged from 2,610 in Lebanon to 180,416 in Sudan with a median of 53,079, and treatment coverage ranged between 40.2 and 78.4% with a median of 60.4%. By 2030, prevalence of chronic infection ranged between 0.0 and 0.3% with a median of 0.1%, and incidence rate, per 100,000 person-years, ranged between 0.9 and 16.3 with a median of 3.2. Program-attributed reduction in incidence rate ranged between 47.8 and 81.9% with a median of 68.5%, and number of averted infections ranged between 401 and 68,499 with a median of 8,703. Number of treatments needed to prevent one new infection ranged from 1.7 in Oman to 25.9 in Tunisia with a median of 6.5. In the target incidence rate < 1 per 100,000 person-years scenario, number of treatments administrated by 2030 ranged from 3,470 in Lebanon to 211,912 in Sudan with a median of 54,479, and treatment coverage ranged between 55.5 and 95.9% with a median of 87.5%. By 2030, prevalence of chronic infection was less than 0.1%, and incidence rate, per 100,000 person-years, reached less than 1. Program-attributed reduction in incidence rate ranged between 61.0 and 97.5% with a median of 90.7%, and number of averted infections ranged between 559 and 104,315 with a median of 12,158. Number of treatments needed to prevent one new infection ranged from 1.3 in Oman to 25.9 in Tunisia with a median of 5.5.
CONCLUSION
HCV-TasP is an effective and indispensable prevention intervention to control MENA's HCV epidemic and to achieve elimination by 2030.
背景
直接作用抗病毒药物为中东和北非（MENA）消除丙型肝炎病毒（HCV）感染带来了契机，该地区是受HCV感染影响最严重的地区。在19个中东和北非国家对丙型肝炎治疗作为预防措施（HCV-TasP）的影响进行了调查。
方法
使用年龄结构数学模型，通过流行病学和规划措施评估项目影响。该模型与系统收集的HCV抗体流行率数据的数据库进行拟合。研究了两种主要的治疗推广方案，以实现（i）到2030年将HCV发病率降低80%，以及（ii）到2030年发病率<1/10万人年。
结果
在目标发病率降低80%的方案中，到2030年给药治疗的数量从黎巴嫩的2610例到苏丹的180416例不等，中位数为53079例，治疗覆盖率在40.2%至78.4%之间，中位数为60.4%。到2030年，慢性感染患病率在0.0%至0.3%之间，中位数为0.1%，每10万人年的发病率在0.9至16.3之间，中位数为3.2。项目归因的发病率降低幅度在47.8%至81.9%之间，中位数为68.5%，避免感染的数量在401至68499之间，中位数为8703例。预防一例新感染所需的治疗数量从阿曼的1.7例到突尼斯的25.9例不等，中位数为6.5例。在目标发病率<1/10万人年的方案中，到2030年给药治疗的数量从黎巴嫩的3470例到苏丹的211912例不等，中位数为54479例，治疗覆盖率在55.5%至95.9%之间，中位数为87.5%。到2030年，慢性感染患病率低于0.1%，每10万人年的发病率低于1。项目归因的发病率降低幅度在61.0%至97.5%之间，中位数为90.7%，避免感染的数量在559至104315之间，中位数为12158例。预防一例新感染所需的治疗数量从阿曼的1.3例到突尼斯的25.9例不等，中位数为5.5例。
结论
HCV-TasP是控制中东和北非地区HCV流行并在2030年实现消除的有效且不可或缺的预防干预措施。
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