Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, England.
National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, England.
J Viral Hepat. 2024 Mar;31(3):131-136. doi: 10.1111/jvh.13906. Epub 2024 Jan 4.
New case-finding opportunities are needed to achieve hepatitis C virus (HCV) elimination in England by the year 2030. HCV antenatal testing is not offered universally in England but is recommended for women with risk factors for HCV (e.g. injecting drug use, being born in a high-prevalence country). The aim of this analysis was to investigate the missed opportunities for HCV antenatal testing among women who had given birth and were subsequently diagnosed with HCV at some time after childbirth. By linking data on live births (2010-2020) to laboratory reports of HCV diagnoses (1995-2021), we identified all women who were diagnosed with HCV after the date of their first childbirth. This group was considered to potentially have experienced a missed opportunity for HCV antenatal testing; HCV-RNA testing and treatment outcomes were also obtained for these women. Of the 32,295 women who gave birth between 2010 and 2020 with a linked diagnosis of HCV (median age: 34 years, 72.1% UK-born), over half (n = 17,123) were diagnosed after childbirth. In multivariable analyses, the odds of being diagnosed with HCV after childbirth were higher in those of Asian Bangladeshi, Black African or Chinese ethnicity and among those born in Africa. Over four-fifths (3510/4260) of those eligible for treatment were linked to treatment, 30.7% (747/2435) of whom had a liver scarring level of at least moderate and 9.4% (228/2435) had cirrhosis. Given the potential opportunity to identify cases of HCV with targeted case-finding through antenatal services, universal opt-out testing should be considered in these settings.
需要新的病例发现机会,才能在 2030 年之前在英格兰消除丙型肝炎病毒(HCV)。英格兰并未普遍提供 HCV 产前检测,但建议对有 HCV 风险因素的妇女进行检测(例如,注射吸毒、出生在高流行国家)。本分析旨在调查在分娩后被诊断出 HCV 的妇女中,HCV 产前检测的遗漏机会。通过将活产数据(2010-2020 年)与 HCV 诊断的实验室报告(1995-2021 年)进行链接,我们确定了所有在首次分娩后被诊断出 HCV 的妇女。这群人被认为可能错过了 HCV 产前检测的机会;还为这些妇女获得了 HCV-RNA 检测和治疗结果。在 2010 年至 2020 年期间分娩并与 HCV 诊断相关联的 32295 名妇女(中位年龄:34 岁,72.1%为英国出生)中,超过一半(n=17123)在分娩后被诊断出患有 HCV。在多变量分析中,在亚洲孟加拉国、黑非洲或中国血统以及在非洲出生的妇女中,分娩后被诊断出 HCV 的可能性更高。在符合治疗条件的 4260 人中,有 3510 人(747/2435)与治疗相关联,其中 30.7%(747/2435)有至少中度肝脏疤痕,9.4%(228/2435)有肝硬化。鉴于通过产前服务进行针对性病例发现有可能发现 HCV 病例,应考虑在这些环境中普遍采用选择退出检测。