Feasibility of hepatitis C elimination by screening and treatment alone in high-income countries.

Autor:	Tian F; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada., Forouzannia F; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada., Feng Z; Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada., Biondi MJ; Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada.; School of Nursing, York University, Toronto, Ontario, Canada., Mendlowitz AB; Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada.; Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada., Feld JJ; Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada., Sander B; Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Public Health Ontario, Toronto, Ontario, Canada., Wong WWL; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.; Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Hepatology (Baltimore, Md.) [Hepatology] 2024 Aug 01; Vol. 80 (2), pp. 440-450. Date of Electronic Publication: 2024 Mar 13.
DOI:	10.1097/HEP.0000000000000779
Abstrakt:	Background and Aims: Despite the availability of highly effective direct-acting antiviral therapy, chronic hepatitis C (CHC) continues to cause a major public health burden. In many high-income countries, treatment rates have been declining, which was exacerbated by the impact of the COVID-19 pandemic, threatening the ability to meet the World Health Organization (WHO)'s targets for eliminating HCV as a public health threat by 2030. We sought to model the impact of CHC in Canada, a resource-rich country with ongoing immigration from HCV-endemic regions; which relies exclusively on risk-based screening for case identification. Approach and Results: We developed an agent-based model to characterize the HCV epidemic in a high-income country with ongoing immigration. Combinations of prevention such as harm reduction, screening, and treatment strategies were considered. Model parameters were estimated from the literature and calibrated against historical HCV data. Sensitivity analyses were performed to assess uncertainty. Under the current status quo of risk-based screening, we predict the incidence of CHC-induced decompensated cirrhosis, HCC, and liver-related deaths would decrease by 79.4%, 76.1%, and 62.1%, respectively, between 2015 and 2030, but CHC incidence would only decrease by 11.1%. The results were sensitive to HCV transmission rate and an annual number of people initiating treatment. Conclusions: Current risk-based screening, and subsequent treatment, will be inadequate to achieve WHO goals. With extensive scale-up in screening, and treatment, the mortality target may be achievable, but the target for preventing new CHC cases is unlikely reachable, highlighting the importance of developing enhanced harm-reduction strategies for HCV elimination. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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