The Impact of New Direct-Acting Antiviral Therapy on the Prevalence and Undiagnosed Proportion of Chronic Hepatitis C Infection in Alberta: A Model-Based Analysis.

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY
Canadian liver journal Pub Date : 2025-04-11 eCollection Date: 2025-05-01 DOI:10.3138/canlivj-2024-0062
Farinaz Forouzannia, Diedron Lewis, Nkiruka Eze, Fiona Clement, William W L Wong
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Abstract

Background: Understanding the impact of wider access to treatment on chronic hepatitis C (CHC) prevalence and the undiagnosed CHC proportion is important to achieving the World Health Organization's 2030 elimination targets. This research aimed to: (1) estimate the CHC prevalence and undiagnosed rates in Alberta, Canada; and (2) explore the impact of new direct-acting antiviral therapy on these rates since its introduction in 2014.

Methods: This study adopted a two-step approach to estimate CHC prevalence and undiagnosed rates. This involved a population-based retrospective analysis of health administrative data for Alberta from 2002 to 2018 to generate CHC-related events for three birth cohorts: individuals born before 1945, individuals born between 1945 and 1965, and individuals born after 1965. A back-calculation method was employed to obtain historical prevalence and incidence estimates.

Results: After the introduction of direct-acting antiviral treatment in 2014, the mean prevalence of CHC over all the birth cohorts fell by approximately 6.5% from 1.23% (95% CI: 0.97%-1.5%) to 1.15% (95% CI: 0.91%-1.45%) between 2015 and 2018. Similar trends were estimated for the 1945-1965 and the >1965 birth cohorts over the same period. Likewise, the mean proportion of undiagnosed CHC infections over all the birth cohorts fell by approximately 8.25% from 39.36% (95% CI: 30.08%-48.48%) to 36.36% (95% CI: 27.49%-45.31%) over the same period. A similar trend was experienced in all three birth cohorts.

Conclusions: This is the first study to estimate CHC prevalence and undiagnosed proportions in Alberta using provincial health administrative data. These results could provide vital evidence to guide decisions about current and future hepatitis C virus strategies and help achieve the World Health Organization goal of eliminating hepatitis C in Canada by 2030.

新型直接抗病毒治疗对阿尔伯塔省慢性丙型肝炎感染患病率和未确诊比例的影响:基于模型的分析
背景:了解更广泛的治疗可及性对慢性丙型肝炎(CHC)患病率和未确诊的CHC比例的影响,对于实现世界卫生组织2030年消除目标至关重要。本研究旨在:(1)估计加拿大阿尔伯塔省CHC患病率和未确诊率;(2)探索自2014年推出的新型直接作用抗病毒药物对这些比率的影响。方法:本研究采用两步法估计CHC患病率和未诊断率。该研究涉及对艾伯塔省2002年至2018年的卫生行政数据进行基于人群的回顾性分析,以生成三个出生队列的chc相关事件:1945年之前出生的个体,1945年至1965年之间出生的个体和1965年之后出生的个体。采用反向计算方法获得历史患病率和发病率估计。结果:2014年引入直接作用抗病毒治疗后,所有出生队列的CHC平均患病率从2015年的1.23% (95% CI: 0.97%-1.5%)下降到2015年至2018年的1.15% (95% CI: 0.91%-1.45%),下降了约6.5%。在同一时期,1945年至1965年和1965年至1965年出生的人群估计也有类似的趋势。同样,在同一时期,所有出生队列中未确诊的CHC感染的平均比例下降了约8.25%,从39.36% (95% CI: 30.08%-48.48%)降至36.36% (95% CI: 27.49%-45.31%)。在所有三个出生队列中都经历了类似的趋势。结论:这是第一项利用省卫生行政数据估计阿尔伯塔省CHC患病率和未确诊比例的研究。这些结果可以为指导当前和未来丙型肝炎病毒战略的决策提供重要证据,并有助于实现世界卫生组织到2030年在加拿大消除丙型肝炎的目标。
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