Modelling the potential effectiveness of hepatitis C screening and treatment strategies during pregnancy in Egypt and Ukraine.

Autor: Hachicha-Maalej N; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France. Electronic address: nadia.hachicha@inserm.fr., Collins IJ; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK., Ades AE; Population Health Sciences, University of Bristol Medical School, Bristol, UK., Scott K; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK., Judd A; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK., Mostafa A; Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt., Chappell E; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK., Hamdy-El-Sayed M; Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt., Gibb D; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK., Pett S; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK; Institute for Global Health, University College London, London, UK., Mariné-Barjoan E; Département de Santé Publique/Pôle Référence Hépatite C, CHU Nice, Nice, France., Volokha A; Department of Paediatric Infectious Diseases and Paediatric Immunology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine., Yazdanpanah Y; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France; Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, F-75018 Paris, France., Deuffic-Burban S; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France. Electronic address: sylvie.burban@inserm.fr.
Jazyk: angličtina
Zdroj: Journal of hepatology [J Hepatol] 2023 May; Vol. 78 (5), pp. 937-946. Date of Electronic Publication: 2023 Jan 18.
DOI: 10.1016/j.jhep.2022.12.032
Abstrakt: Background & Aims: HCV test and treat campaigns currently exclude pregnant women. Pregnancy offers a unique opportunity for HCV screening and to potentially initiate direct-acting antiviral treatment. We explored HCV screening and treatment strategies in two lower middle-income countries with high HCV prevalence, Egypt and Ukraine.
Methods: Country-specific probabilistic decision models were developed to simulate a cohort of pregnant women. We compared five strategies: S0, targeted risk-based screening and deferred treatment (DT) to after pregnancy/breastfeeding; S1, World Health Organization (WHO) risk-based screening and DT; S2, WHO risk-based screening and targeted treatment (treat women with risk factors for HCV vertical transmission [VT]); S3, universal screening and targeted treatment during pregnancy; S4, universal screening and treatment. Maternal and infant HCV outcomes were projected.
Results: S0 resulted in the highest proportion of women undiagnosed: 59% and 20% in Egypt and Ukraine, respectively, with 0% maternal cure by delivery and VT estimated at 6.5% and 7.9%, respectively. WHO risk-based screening and DT (S1) increased the proportion of women diagnosed with no change in maternal cure or VT. Universal screening and treatment during pregnancy (S4) resulted in the highest proportion of women diagnosed and cured by delivery (65% and 70%, respectively), and lower levels of VT (3.4% and 3.6%, respectively).
Conclusions: This is one of the first models to explore HCV screening and treatment strategies in pregnancy, which will be critical in informing future care and policy as more safety/efficacy data emerge. Universal screening and treatment in pregnancy could potentially improve both maternal and infant outcomes.
Impact and Implications: In the context of two lower middle-income countries with high HCV burdens (Egypt and Ukraine), we designed a decision analytic model to explore five different HCV testing and treatment strategies for pregnant women, with the assumption that treatment was safe and efficacious for use in pregnancy. Assuming direct-acting antiviral treatment during pregnancy would reduce vertical transmission, our findings indicate that the provision of universal (rather than risk-based targeted) screening and treatment would provide the greatest maternal and infant benefits. While future trials are needed to assess the safety and efficacy of direct-acting antivirals in pregnancy and their impact on vertical transmission, there is increasing recognition that the elimination of HCV cannot leave entire subpopulations of pregnant women and young children behind. Our findings will be critical for policymakers when developing improved screening and treatment recommendations for pregnant women.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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