目的:据估计,全世界有326万儿童和青少年患有慢性HCV感染。迄今为止,全球的反应集中在成年人身上,但直接作用抗病毒(DAA)方案现已批准用于≥3岁儿童.这篇全球综述描述了儿童HCV检测和治疗政策的现状,青少年,世卫组织会员国的孕妇。
方法:我们从世界卫生组织(WHO)截至2019年8月的成员国国家政策数据库中确定了HCV感染的国家战略计划和/或临床实践指南(CPG)。标准化形式用于抽象有关政策的数据或有关儿童测试和治疗的建议,青少年和孕妇。根据国家收入状况对分析进行了分层,并通过世卫组织区域联络点对结果进行了验证,直至2020年8月。
结果:世卫组织194个会员国中的122个国家有国家HCV政策。其中,大多数(n=71/122,58%)没有针对儿童或青少年的检测或治疗提出政策建议.在51个有政策的国家中,24有具体的测试和治疗政策,主要来自欧洲地区;18个国家仅用于HCV检测(12个来自高收入或中高收入);9个国家仅用于治疗(7个高收入或中高收入)。21个国家提供了具体的治疗建议:13个推荐的基于DAA的青少年≥12岁的方案和6个仍推荐的基于干扰素/利巴韦林的方案。
结论:HCV感染儿童和青少年的政策存在显著差距。需要更新针对年轻年龄组的新批准的DAA方案的测试和治疗指南,尤其是在受影响最大的国家。
背景:迄今为止,消除丙型肝炎的全球应对措施的主要重点一直是成年人的检测和治疗。对儿童和青少年的检测和治疗的关注要少得多,尽管在2018年估计有326万人感染了HCV。我们的审查表明,许多国家没有关于儿童和青少年HCV检测和治疗的国家指南。它强调迫切需要宣传和更新专门针对儿童和青少年的政策和准则。
OBJECTIVE: It is estimated that 3.26 million children and adolescents worldwide have chronic HCV infection. To date, the global response has focused on the adult population, but direct-acting antiviral (DAA) regimens are now approved for children aged ≥3 years. This global review describes the current status of policies on HCV testing and treatment in children, adolescents, and pregnant women in WHO Member States.
METHODS: We identified national strategic plans and/or clinical practice
guidelines (CPGs) for HCV infection from a World Health Organization (WHO) database of national policies from Member States as of August 2019. A standardised proforma was used to abstract data on polices or recommendations on testing and treatment in children, adolescents and pregnant women. Analysis was stratified according to the country-income status and results were validated through WHO regional focal points through August 2020.
RESULTS: National HCV policies were available for 122 of the 194 WHO Member States. Of these, the majority (n = 71/122, 58%) contained no policy recommendations for either testing or treatment in children or adolescents. Of the 51 countries with policies, 24 had specific policies for both testing and treatment, and were mainly from the European region; 18 countries for HCV testing only (12 from high- or upper-middle income); and 9 countries for treatment only (7 high- or upper-middle income). Twenty-one countries provided specific treatment recommendations: 13 recommended DAA-based regimens for adolescents ≥12 years and 6 still recommended interferon/ribavirin-based regimens.
CONCLUSIONS: There are significant gaps in policies for HCV-infected children and adolescents. Updated guidance on testing and treatment with newly approved DAA regimens for younger age groups is needed, especially in most affected countries.
BACKGROUND: To date, the predominant focus of the global response towards elimination of hepatitis C has been on the testing and treatment of adults. Much less attention has been paid to testing and treatment among children and adolescents, although in 2018 an estimated 3.26 million were infected with HCV. Our review shows that many countries have no national guidance on HCV testing and treatment in children and adolescents. It highlights the urgent need for advocacy and updated policies and
guidelines specific for children and adolescents.