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Dugan E, Blach S, Biondi M, Cai Z, DePaola M, Estes C, Feld J, Gamkrelidze I, Kottilil S, Ma S, Mathur P, Montoya S, Razavi-Shearer D, Razavi-Shearer K, Robbins-Scott S, Schmelzer J, Razavi H. Global prevalence of hepatitis C virus in women of childbearing age in 2019: a modelling study. Lancet Gastroenterol Hepatol 2021; 6:169-184. [PMID: 33515496 DOI: 10.1016/s2468-1253(20)30359-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment for infection with hepatitis C virus (HCV) during pregnancy has not yet been approved; however, interventions specifically targeting women, especially those of childbearing age (15-49 years), could prevent vertical transmission and community spread. To assess the impact of such interventions, improved prevalence estimates in this group are needed. We aimed to estimate the global prevalence of viraemic HCV in 2019 among women of childbearing age. METHODS In this modelling study, we used previously developed models for 110 countries inputted with country-specific demographic and HCV epidemiology data. We did a literature review, searching PubMed, Embase, and grey literature for studies published between Jan 1, 2000, and June 30, 2018, reporting HCV antibody or viraemic prevalence in women of childbearing age. Studies from the literature review and studies in models were compared by use of a data quality scoring system and models were updated, as appropriate, when a better study was identified. We used these HCV disease burden models to calculate the 2019 prevalence of viraemic HCV in women of childbearing age. In countries without a model, prevalence was extrapolated by Global Burden of Disease (GBD) region. FINDINGS An estimated 14 860 000 (95% uncertainty interval [UI] 9 667 000-18 282 000) women aged 15-49 years had HCV infection worldwide in 2019, corresponding to a viraemic prevalence of 0·78% (95% UI 0·62-0·86). Globally, HCV prevalence increased with age, rising from 0·25% (95% UI 0·20-0·27) in women aged 15-19 years to 1·21% (0·97-1·34) in women aged 45-49 years. China (16% of total infections) and Pakistan (15%) had the greatest numbers of viraemic infections, but viraemic prevalence was highest in Mongolia (5·14%, 95% CI 3·46-6·28) and Burundi (4·91%, 3·80-18·75). Of the countries with 500 cases or more, viraemic prevalence was lowest in Chile (0·07%, 95% UI 0·04-0·12). Among the GBD regions, eastern Europe had the highest viraemic prevalence (3·39%, 95% UI 1·88-3·54). By WHO region, the Eastern Mediterranean region had the highest viraemic prevalence (1·75%, 95% UI 1·26- 1·90). INTERPRETATION Most research on HCV disease burden among women aged 15-49 years focuses on pregnant women. Using modelling, this analysis provides global and national estimates of HCV prevalence in all women of childbearing age. These data can inform preconception test-and-treat strategies to reduce vertical transmission and total disease burden. FUNDING Gilead Sciences, John C Martin Foundation, private donors.
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Affiliation(s)
- Ellen Dugan
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Sarah Blach
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Mia Biondi
- Toronto Centre for Liver Disease, Viral Hepatitis Care Network, University Health Network, Toronto, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Zongzhen Cai
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Mindi DePaola
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Chris Estes
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Jordan Feld
- Toronto Centre for Liver Disease, Viral Hepatitis Care Network, University Health Network, Toronto, ON, Canada; Department of Gastroenterology and Hepatology, University of Toronto, Toronto, ON, Canada
| | | | | | - Siya Ma
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Poonam Mathur
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Shauna Montoya
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | | | | | | | | | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA.
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Schmelzer J, Dugan E, Blach S, Coleman S, Cai Z, DePaola M, Estes C, Gamkrelidze I, Jerabek K, Ma S, Montoya S, Razavi-Shearer D, Razavi-Shearer K, Robbins-Scott S, Razavi H, El Sayed MH. Global prevalence of hepatitis C virus in children in 2018: a modelling study. Lancet Gastroenterol Hepatol 2020; 5:374-392. [DOI: 10.1016/s2468-1253(19)30385-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023]
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Idilman R, Razavi H, Robbins-Scott S, Akarca US, Örmeci N, Kaymakoglu S, Aygen B, Tozun N, Güner R, Bodur H, Lazarus JV. A micro-elimination approach to addressing hepatitis C in Turkey. BMC Health Serv Res 2020; 20:249. [PMID: 32209103 PMCID: PMC7093960 DOI: 10.1186/s12913-020-5019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. METHODS Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. RESULTS At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10-25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45-70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80-85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. CONCLUSIONS To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, CO 80026 USA
| | | | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University Medical Faculty, Izmir, Turkey
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Nurdan Tozun
- Department of Internal Medicine and Gastroenterology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases, Ankara Numune Training and Research Hospital, University of Healthcare Sciences, Ankara, Turkey
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, 4th Floor, ES-08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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