通过抗丙型肝炎病毒（HCV）反射性HCV抗原检测进行基于患病率的筛查以及提供可及的筛查后护理以消除农村地区的丙型肝炎
Prevalence-based screening by anti-HCV reflex HCV antigen test and accessible post-screening care towards elimination of hepatitis C in rural villages.
作者信息
Pan Kuan-Chen, Hsu Nien-Tzu, Tang Ying-Mei, Lee Yu-Chen, Kuo Hsiu-Ling, Huang Tung-Jung, Tseng Chun-Mei, Lu Sheng-Nan, Chang Te-Sheng
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Yunlin, Taiwan.
Biostatistics and Bioinformatics Center of Kaohsiung, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
出版信息
BMC Gastroenterol. 2025 May 23;25(1):400. doi: 10.1186/s12876-025-03990-0.
BACKGROUND
One major barrier to the goals of hepatitis C virus (HCV) elimination is identification and linkage-to-care for those with HCV infection. The aim of this research was to develop a strategy to help achieve HCV elimination in remote rural villages.
METHODS
According to the maps of the township- and village-specific testing rates and prevalence rates of anti-HCV produced by the Public Health Bureau of Yunlin County, a high anti-HCV prevalent township Sihhu and four nearby villages were selected for an intensive screening with anti-HCV reflex HCV antigen test. A temporary outreach hepatology clinic was set in Sihhu Township Health Center to enhance accessibility for post-screening care of those positive for HCV antigen.
RESULTS
The population aged ≥ 40 years of the included villages at time of survey was 18,018 with 5,343 (29.7%, range 18.8-39.7%) having ever been previously screened, and 1,503 responded to this screening. The crude screening coverage rate increased to 38.0% (range 27.6-47.2%) after this screening campaign. The prevalence rates of anti-HCV and HCV antigen were 17.3% and 8.3% respectively, with the rate of antigenemia (HCV antigen/anti-HCV) being 48.1%. The number needed to test (NNT) to find a candidate for anti-viral treatment was 12. Patients can choose any medical institution for consultation based on their preference. The local health centers could trace the consultation status of all 125 HCV patients, with 119 of them receiving direct-acting antiviral (DAA) treatment. Out of the 125 patients with positive HCV antigen, 75 were evaluated at the outreach clinic, with 70 ultimately receiving DAA treatment at the outreach clinic and 5 receiving treatment at other hospitals. Evaluable sustained virological response rate for the 70 patients was 97%.
CONCLUSION
Prevalence-based screening and accessible outreach clinic can help accelerate HCV elimination in rural villages.
背景
丙型肝炎病毒（HCV）消除目标的一个主要障碍是对HCV感染者的识别和治疗衔接。本研究的目的是制定一项策略，以帮助在偏远农村实现HCV消除。
方法
根据云林县卫生局制作的乡镇和村庄特异性抗-HCV检测率及患病率地图，选择抗-HCV高流行乡镇四湖及附近四个村庄进行抗-HCV反射HCV抗原检测的强化筛查。在四湖乡卫生中心设立临时外展肝病诊所，以提高HCV抗原阳性者筛查后护理的可及性。
结果
调查时纳入村庄的≥40岁人群为18018人，其中5343人（29.7%，范围18.8%-39.7%）曾接受过筛查，1503人对此次筛查做出回应。此次筛查活动后，粗筛查覆盖率提高到38.0%（范围27.6%-47.2%）。抗-HCV和HCV抗原的患病率分别为17.3%和8.3%，病毒血症（HCV抗原/抗-HCV）率为48.1%。找到一名抗病毒治疗候选者所需的检测数（NNT）为12。患者可根据自己的意愿选择任何医疗机构进行咨询。当地卫生中心能够追踪所有125名HCV患者的咨询情况，其中119人接受了直接抗病毒药物（DAA）治疗。在125名HCV抗原阳性患者中，75人在 outreach诊所接受评估，其中70人最终在outreach诊所接受DAA治疗，5人在其他医院接受治疗。70名患者的可评估持续病毒学应答率为97%。
结论
基于患病率的筛查和可及的外展诊所有助于加速农村地区的HCV消除。
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