The past five years have seen a revolution in the treatment of chronic hepatitis C, as short duration oral regimens of direct-acting antiviral drugs (DAAs), with nearly 100% cure rates for all genotypes, have replaced longer courses of ribavirin and injected interferon. Although initially very expensive, these DAAs are now becoming available in generic equivalents in countries with large numbers of chronically infected people, such as India. However, a number of obstacles may hinder the delivery of these drugs in resource-limited settings, including lack of access to diagnostic testing and the restriction of treatment to a small number of medical specialists. New approaches are therefore needed to make DAAs available to the estimated 71 million infected people, many of whom disproportionately live in low- or middle-income countries. A recent pilot study (ASCEND) of hepatitis C management in a low-income population in Washington, D.C., demonstrated that trained nurse practitioners, primary care physicians and hepatologists were equally successful in diagnosing and treating patients, indicating that such an approach might be successful in resource-limited regions of the world. Members of the Global Virus Network have received funding to carry out a similar training project in a region of India with a high prevalence of hepatitis C. This paper reviews the challenges of delivering DAA therapy in low- and middle-income countries, describes plans for performing and evaluating the effectiveness of a training program in India, and discusses future needs for the eventual elimination of hepatitis C.

在过去的五年中，慢性丙型肝炎的治疗发生了革命，因为直接作用的抗病毒药物（DAA）的短期口服方案对所有基因型的治愈率均接近100％，已取代了更长疗程的利巴韦林和注射干扰素。尽管这些DAA最初很昂贵，但现在已在具有大量慢性感染人群的国家（如印度）以通用等效品的形式提供。但是，许多障碍可能会阻碍这些药物在资源有限的环境中的交付，包括无法获得诊断性检测结果以及将治疗方法限制于少数医学专家的情况。因此，需要采取新的方法，使估计有7100万感染者能够使用DAA，其中许多人生活在低收入或中等收入国家。最近在华盛顿特区的低收入人群中进行的丙型肝炎管理的试点研究（ASCEND）表明，训练有素的执业执业医师，初级保健医生和肝病医生在诊断和治疗患者方面同样成功，表明这种方法可能是成功的在世界上资源有限的地区。全球病毒网络的成员已获得资助，在印度丙型肝炎高发地区开展类似的培训项目。本文回顾了在低收入和中等收入国家提供DAA疗法的挑战，并描述了计划。在印度执行和评估培训计划的有效性，并讨论了最终消除丙型肝炎的未来需求。证明受过训练的护士，初级保健医师和肝病学家在诊断和治疗患者方面同样成功，表明这种方法在世界资源有限的地区可能是成功的。全球病毒网络的成员已获得资助，在印度丙型肝炎高发地区开展类似的培训项目。本文回顾了在低收入和中等收入国家提供DAA疗法的挑战，并描述了计划。在印度执行和评估培训计划的有效性，并讨论了最终消除丙型肝炎的未来需求。证明受过训练的护士，初级保健医师和肝病学家在诊断和治疗患者方面同样成功，表明这种方法在世界资源有限的地区可能是成功的。全球病毒网络的成员已获得资金，以在丙型肝炎高发的印度地区开展类似的培训项目。本文回顾了在低收入和中等收入国家提供DAA疗法的挑战，并描述了计划。在印度执行和评估培训计划的有效性，并讨论了最终消除丙型肝炎的未来需求。表明这种方法在世界资源有限的地区可能会成功。全球病毒网络的成员已获得资金，以在丙型肝炎高发的印度地区开展类似的培训项目。本文回顾了在低收入和中等收入国家提供DAA疗法的挑战，并描述了计划。在印度执行和评估培训计划的有效性，并讨论了最终消除丙型肝炎的未来需求。表明这种方法在世界资源有限的地区可能会成功。全球病毒网络的成员已获得资金，以在丙型肝炎高发的印度地区开展类似的培训项目。本文回顾了在低收入和中等收入国家提供DAA疗法的挑战，并描述了计划。在印度执行和评估培训计划的有效性，并讨论了最终消除丙型肝炎的未来需求。