Qureshi Mahnoor
School of Health Sciences, The University of Manchester, Manchester, UK.
J Viral Hepat. 2025 Jan;32(1):e14050. doi: 10.1111/jvh.14050.
Hepatitis C virus infection is a serious liver disease that can progress to cirrhosis and, in chronic cases, lead to liver cancer or liver failure. Pakistan has the second highest burden of HCV in the world, a rising number of liver cancer cases and a unique pattern of healthcare-associated HCV transmission. Unfortunately, the country is not on track to meet the WHO's target of complete elimination of HCV by 2030. The current reliance on vertical programmes for hepatitis elimination may seem effective in the short term, but is often unsustainable, ineffective and contributes to the fragmentation of the health system. This review proposes a health system strengthening approach to HCV detection and prevention in the country. It critically evaluates the country's health system and the existing evidence on HCV prevention and treatment, proposing evidence-based strategies for decentralising HCV services and integrating them into the primary healthcare infrastructure. It examines the effectiveness of methods such as task shifting and targeted interventions while suggesting changes to healthcare practices to reduce healthcare-associated transmission of HCV and other blood-borne pathogens.
丙型肝炎病毒感染是一种严重的肝脏疾病，可发展为肝硬化，在慢性病例中，会导致肝癌或肝衰竭。巴基斯坦是全球丙型肝炎负担第二高的国家，肝癌病例数不断上升，且存在与医疗保健相关的丙型肝炎病毒传播的独特模式。不幸的是，该国未能按计划在2030年前实现世界卫生组织完全消除丙型肝炎的目标。目前依靠垂直项目来消除肝炎在短期内可能看似有效，但往往不可持续、效果不佳，还会导致卫生系统碎片化。本综述提出了一种加强该国卫生系统以进行丙型肝炎检测和预防的方法。它批判性地评估了该国的卫生系统以及关于丙型肝炎预防和治疗的现有证据，提出了将丙型肝炎服务去中心化并将其纳入初级医疗保健基础设施的循证策略。它考察了任务转移和有针对性干预等方法的有效性，同时建议改变医疗保健做法，以减少与医疗保健相关的丙型肝炎病毒及其他血源性病原体的传播。
