Background

WHO has set targets to eliminate hepatitis C virus (HCV) infection as a global health threat by 2030 through a 65% reduction in HCV-related deaths and 80% reduction in HCV incidence. To achieve these goals, WHO set service coverage targets of 90% of the infected population being diagnosed and 80% of eligible patients being treated. In February, 2016, Iceland initiated a nationwide HCV elimination programme known as treatment as prevention for hepatitis C (TraP HepC), which aimed to maximise diagnosis and treatment access. This analysis reports on the HCV cascade of care in the first 3 years of the programme.

Methods

This population-based study was done between Feb 10, 2016, and Feb 10, 2019. Participants aged 18 years or older with permanent residence in Iceland and PCR-confirmed HCV were offered direct-acting antiviral (DAA) therapy. The programme used a multidisciplinary team approach in which people who inject drugs were prioritised. Nationwide awareness campaigns, improved access to testing, and harm reduction services were scaled up simultaneously. The number of infected people in the national HCV registry was used in combination with multiple other data sources, including screening of low-risk groups and high-risk groups, to estimate the total number of HCV infections. The number of people diagnosed, linked to care, initiated on treatment, and cured were recorded during the study. This study is registered with ClinicalTrials.gov, NCT02647879.

Findings

In February, 2016, at the onset of the programme, 760 (95% CI 690–851) individuals were estimated to have HCV infection, with 75 (95% CI 6–166) individuals undiagnosed. 682 individuals were confirmed to be HCV PCR positive. Over the next 3 years, 183 new infections (including 42 reinfections) were diagnosed, for a total of 865 infections in 823 individuals. It was estimated that more than 90% of all domestic HCV infections had been diagnosed as early as January, 2017. During the 3 years, 824 (95·3%) of diagnosed infections were linked to care, and treatment was initiated for 795 (96·5%) of infections linked to care. Cure was achieved for 717 (90·2%) of 795 infections.

Interpretation

By using a multidisciplinary public health approach, involving tight integration with addiction treatment services, the core service coverage targets for 2030 set by WHO have been reached. These achievements position Iceland to be among the first nations to subsequently achieve the WHO goal of eliminating HCV as a public health threat.

Funding

The Icelandic Government and Gilead Sciences.

中文翻译：

---

冰岛丙型肝炎预防 (TraP HepC) 计划治疗的前 36 个月的级联护理：一项基于人群的研究

背景

世卫组织已制定目标，到 2030 年消除丙型肝炎病毒 (HCV) 感染这一全球健康威胁，将 HCV 相关死亡人数减少 65%，将 HCV 发病率降低 80%。为实现这些目标，世卫组织设定了服务覆盖目标，即 90% 的感染人群得到诊断，80% 的合格患者得到治疗。2016 年 2 月，冰岛启动了一项全国性的 HCV 消除计划，称为丙型肝炎预防治疗 (TraP HepC)，旨在最大限度地提高诊断和治疗的可及性。该分析报告了该计划前 3 年的 HCV 级联护理。

方法

这项基于人群的研究是在 2016 年 2 月 10 日至 2019 年 2 月 10 日期间完成的。 向 18 岁或以上、在冰岛永久居住且 PCR 确认为 HCV 的参与者提供直接作用抗病毒 (DAA) 治疗。该计划采用多学科团队方法，优先考虑注射吸毒者。全国范围内的宣传活动、改进的检测机会和减少危害服务同时扩大。将国家 HCV 登记中的感染人数与其他多个数据源结合使用，包括筛查低风险群体和高风险群体，以估计 HCV 感染的总数。研究期间记录了诊断、与护理相关、开始治疗和治愈的人数。本研究已在 ClinicalTrials.gov 注册，NCT02647879。

发现

2016 年 2 月，在该计划开始时，估计有 760 (95% CI 690–851) 个人感染了 HCV，其中 75 (95% CI 6–166) 个人未确诊。682 人被确认为 HCV PCR 阳性。在接下来的 3 年中，诊断出 183 例新感染（包括 42 例再感染），总共有 823 人感染了 865 例。据估计，早在 2017 年 1 月，国内所有 HCV 感染中就有 90% 以上被确诊。 3 年间，824 例（95·3%）确诊感染与护理相关，并开始治疗 795 例（ 96·5%) 的感染与护理有关。795 例感染中有 717 例 (90·2%) 治愈。

解释

通过使用多学科公共卫生方法，包括与成瘾治疗服务的紧密结合，世卫组织设定的 2030 年核心服务覆盖目标已经实现。这些成就使冰岛成为随后实现消除 HCV 作为公共卫生威胁的世卫组织目标的首批国家之一。

资金

冰岛政府和吉利德科学。