健康中国2030消除丙肝威胁行动白皮书.pdf

?2030?1?2016-2021?2016-2021?“?”?11.11.21.322.12.233.13.23.33.4?122.12.233.13.23.33.43.5?122.12.22.32.42.533.13.23.34?06071417252729334142457486?2?3?4?Hepatitis C?World Health Organization,WHO?7 100?2030?2016?2021?GHSS?2030?2014?2017?2017-2020?2019?3?DDAs?“?”?760?5?2019?12?“?”?2020?2030?“?“?2030?1.?“?203?”?06?7?1.?1.1?HCV?HCV?2-24?15%45%?6?6?HCV?55%85%?20?15%30%?1%3%?8HCV?1?2?3?4?HIV?HIV?HCV?HCV?-HCV?HCV?HCV RNA?HCV?1-2?HCV RNA?50?70?-HCV?78?90?-HCV?-HCV?HCV RNA?-HCV?“?-HCV?”?HCV RNA?HCV RNA?HCV?HCV RNA?HCV?HCV?-HCV?HCV RNA?-HCV?HCV RNA?HCV?7?1-7?1a?1b?HCV?1?1b?1b?3?HCV?1.2?WHO?90%?117?-HCV?3%?1.8?7 100?300-400?HCV?20%?7.4%?9?39.9?WHO?2.3%?1.0%?6.3%?7.0%?4.2%?4.3%?3.3%?2.2%?3.0%?WHO?2016?1.1?10?3.8%?6.4%?2.1%?1?WHO?2015?23.7/10?WHO?2016?1.2 WHO?2015?11?HCV?HCV?-HCV?35%61%?HCV?60%80%?HCV?30?HCV?HCV?1?46.2%?3?30.1%?2?4?6?22.8%?5?1%2?1.3 HCV?12?1?HCV?33%?HCV?1?1.3?-HCV?-HCV?0.43%?1%?760?HCV?HCV?HCV?HCV?HCV?1?-HCV?48.67%?2016?250?120?HCV?2?HIV?HCV?60%90%?70?4060?HIV?HCV?3?-HCV?6.59%?2016?447 435?3?4?-HCV?0.84%3?500?1 000?HCV?13?4?8?5?HCV?-HCV?0.08%0.50%?-HCV?0.09%0.26%?-HCV?0.54%?0.27%?0.40%?0.53%?0.29%?-HCV?50-59?-HCV?0.77%?-HCV?1-4?-HCV?0.09%?HCV 1b?2a?1b?56.8%?2?24.4%?3?3a 7.06%?3b 5.2%?4?5?4?1?45.2%?36.8%?2?3?3?6?3?5?3?3b?3a?5?14?760?HCV?-HCV?HCV?HIV?HCV?Huiying Rao,Lai Wei et al.Distribution and clinical correlates of viral and host genotypes in C hinese patients with chronic hepatitis C virus infection.?1.4?152.?2.1?WHO?Disability-Adjusted Life Years,DALY?DALY?20?1.5?16?10%15%?10?80%?10?25%?1?33%6?1990-2010?20?15-49?50-69?DALY?15-49?20?48.70%?DALY?22.4%?50-59?30.14%?DALY?50.79%?20?70?36.74%?50-59?14.29%?20?DALY?61.40%?HCV?2.2?22.51%?3.49%7?2016?HCV?8?1.8?4?8.5?62.9?9.2?2019?39244?14 389?40?2019?100%?100%?300%?200%?500%?17?15?42?25.4?41.23?42.77?9?HCV?3.?DAA?alpha?PR?DAA?PR?DAA?3.1?alpha?DAA?alpha?PR?HCV?Sustained Virological Response?SVR?24?HCV?71?1b?SVR?62?PR?HCV?PR?23?52?PR?7?1822?3.2?DAA?DAA?HCV?NS3/4A?NS5B?NS5A?HCV?HCV?HCV?SVR?2011?DAA?1?alpha?PR?SVR?2013?DAA?2?3?SVR?90%?2016?6?SVR?95%99%?SVR?94%?DAA?HCV?90%?SVR?48?8?12?HCV?3.3?DAA?2017?4?1b?2017?11?2?3?2018?5?1?4?2018?5?/?1-6?HCV?1-6?HCV?98%?2018?12?19?1-6?HCV?12?18?2019?5?1-6?HCV?8?2019?12?/?/?DAA?HCV?2018?1?2020?2?11?2020?3?17?DAA?2019?11?2019?DAAs?85%?3.4?DAA?DAA?-?DAA?3.4.1?-?-?,?2010?DAA?DAA?2018?3?DAA?/?1b?PR?alpha?1b?-?PR?1b?11?HCV?1b?Markov?QALY?,?,?/?1b?1.2?1b?-?-?,?,?/?1b?DAA?/?PR?PR?21?/?11?2019?DAA?-?94 470.4?QALY?13.7829?242 784.5?QALY?12.557 8 12?PR?2?DAA?12?59 880?69 600?6 600?13 000?1b?1b?DAA?DAA?DAA?60%?23%?DAA?3.4.2?13?2019?3?DAA?DAA?DAA?22?14，15，16?2019?1b?DAA?DAA?6?DAA?2018?1.3?2018?2022?5?DAA?5?19.63%?5?92.30%?2018?2019?10?23505?11 817.37?DAA?DAA?15?3?DAA?85%?30%?50%?DAA?2018?2017-2030?2030?12 019?48 719?2030?36 699?8.3%?16%?41?DAA?DAA?DAA?760?1b?DAA?1 200?760?200?2018?24?PR?DAA?5?4?,10?21?,15?183?,25?470?17?DAA?-?DAA?2.?“?2030”?25?26?DAA?DAA?2016-2021?“WHO?”?2030?“?”18?“?80%?65%?90%?80%?”?WHO?WHO?124?DAA?“?”?27?1?WHO?2012?WHO?2015-2016?6?28?2013?88.9%?91.3%?-HCV?“?”?“?”?2000?39%?2010?5%?34.1%?2030?300?2015?27?/?82.5%?HCV?49.0%?HCV?1945-1965?HCV?20%?1 400?2.2?36%?6%?46%?6%?12%?8%?2%?2015?540?2015?2015?29?DAA?7 100?DAA?DAA?DAA?Blue Cross?DAA?DAA?DAA?DAA?2015?DAA?SVR?80%?843?SVR?88%?63%?SVR?DAA?WHO?2?2016-2021?2.1?2016-2021?1989?4?HCV?20?HCV?2010?63?WHO?WHO?WHA63.18?7?28?2014?67?30?WHA67.6?WHA63.18?2016-2021?2015?2016-2021?2010?2014?2016?5?69?2030?90%?65%?5?2030?600?1 000?2030?90?140?2030?50?31?32?2015?2030?80%?HCV?65%?2030?90%?80%?WHO?HCV?1?2?3?19?WHO?2.2?WHO 2019?4?124?WHO?2019?45?WHO?2030?45?30?2050?2030?80%?34?65%?30?90%?20?80%?33?26?80%?WHO 2030?67%?20?WHO?2008-2015?8?30%20?WHO?90%?80%?2018?HCV?760?177.5?18%?12.5?1.3%?WHO?2030?3.?WHO?3.1?WHO?34?3.1.1?2015?4?Stop-hepatitis C?STOP-C?2020?90%?2.5?-HCV?2015?STOP-C?HCV?2017?371.7?15?2017?4?43 989?HCV?33 673?DAAs?24 273?2019?4?6?DAA?21 3.1.2?HCV?2006?HCV?HCV?NCCVH?2014?9?2020?HCV?50?35?3.5?88%?12%?1?1150?45.3?2015?3%?2016?10%?2018?12?11?2 000?11?1 877?3.2?“?”?“?”?3.2.1 “?”?“?”?HIV?“?”?3.2.1.1?Springburn?36?HCV?DAA?95.7%?68%?12?Springburn?“?”?HCV?HCV?SVR?3.2.1.2?“?”?/?2019?1?“?HCV?”?HCV?1 113?315?28%?-HCV?DAA?12?3.2.2?320?17 000?8.3%?“?”?“?”?0.8%22?Medicaid?Medicaid?1%?Medicaid?2014?11?23?373.3?WHO?80%?DAA?DAA?4%?19%?65%?24?2019?AASLD?EASL?APASL?ALEH?4?1?HCV“?”?HCV?DAA?12?2?SVR?2?HIV?3?4?38?3.4?DAA?WHO?2020?“75%?90%?”?100%?SVR?2019?Medicaid?DAA?“?”?Medicaid?39 000?Medicaid?Medicaid?2018?Medicaid?3%?2?3?7?6000?3500?1?7500?2020?1?Medicaid?5?Medicaid?3.5?39?“?”?HCV?“?”?25?DAA?DAA?40?DAA?3.?“?2030”?41?42?11?2017?2017-2020?WHO?“?2030”?DAA?1.?1989?HCV?90?1993?-HCV?1995?1998?2003?2004?2004?43?“?2030”?WHO“2030?”?3.1?近年国家层面丙肝防治政策与相关工作近年国家层面丙肝防治政策与相关工作预防预防监测监测筛查筛查诊疗诊疗用药用药保障保障主导部门主导部门20142014丙型病毒性肝炎筛查及管理标准发布?国家卫健委20152015丙型肝炎防治指南（2015年版）发布?中华医学会肝病学分会与感染病学分会关于做好血站核酸检测工作的通知?国家卫健委，财政部20162016多种丙肝DAA药物进入快速审批通道?国家药品监督管理局20172017中国病毒性肝炎防治规划（2017-2020）发布?国家卫健委等11个部门多种丙肝DAA药物获批上市?国家药品监督管理局中国消除丙型肝炎联盟成立?中联肝健康促进中心20182018丙型肝炎诊断（WS213-2018）标准发布?国家卫健委丙通沙纳入国家基本药品目录?国家卫健委20192019丙型肝炎防治指南（2019年版）发布?中华医学会肝病学分会与感染病学分会3种丙肝DAA药物纳入国家医保目录?国家医保局?44?11?2017?2017-2020?“?”?“?2030”?“?”?50%?HCV?100%?7?1?2?3?4?5?6?5?2014?2018?WS213-2018?2019?2019?2019?DAA?45?DAA?2019?3?DAA?2011?FDA?DAA?DAA?DAA?2016?4?18?28?18?10?27?DAA?2017?DAA?2018?DAA?DAA?DAA?2019?11?DAA?85%?DAA?2.?2.1?2017-2020?46?1?2?3?2.1.1?HCV?HCV?HCV?HCV?2008?2013?59.69%?80%?22.36%?26，27，28，29?472016?5?1002?HCV?HCV?2.5%?0.60%?30?HCV?-HCV?3.15%10.5%?0.60%?31?HCV?,?HCV?HCV?2.1.2?-HCV?HCV RNA?HCV?“?”?48?HCV RNA?HCV?2015?“?”?82?23?“?”?“?”?57?WHO?2009?5?32?HCV?2.1.3?49?HCV?2015?9?9?19.46%?51.5%?9.93%?2016?HCV?50%33?2017-2020?“?HCV?/?”?2015?2018?50%70%?34，35，36?50?2009?4?650?2%,?10%?37?2.1.4?10?5%?2019?45 015.54?700?1.6%?2011?2015?51?2017-2020?50%?2012?14%?“?”?“?”?2015?4?25%?2.1.5?2.2?52?2.2.1?2010?HCV?HCV?5?2017?5?87?31?2 000?20?16?2 000?13?13?12?12?11?11?3?400?1?4-6?5?2016-2017?31?-HCV?4.39%4.46%?-HCV?0.70%0.85%?3?-HCV?53?WHO?HCV?“?”?2.2.2?2.2.2.1?2004?37?/?/?/?54?/?HCV RNA?-HCV?HCV RNA?HCV RNA?HCV RNA?24?24?55?1997-2003?27.89%?2003?2.1?2004-2011?48.79%?2012-2016?180?20.4?0.65%?5?1?4?36.6%?3.3?2.2.2.2?(1)?56?2004?2009-2011?3.8%?3?6.9%38?3?20%?2012?2?2013?5-9?5?20?39?-HCV?44.3%?2014?2015?3?2013?3 200?50.86%?;?42.4%?38?HCV?HCV?HCV?HCV?HCV RNA?572.2.3?HCV?2.2.4?HCV?2.3?80%?58?“?”?2.3.1?2014?12?15?2015?2019?“?”?HCV?-HCV?-HCV?HCV RNA?HCV RNA?2.3.2?2019?4?4?2.3.2.1?59?HCV?HCV RNA?HCV?2018?240.4?-HCV?48.67%?HCV?117?2018?125?HCV?75%90%?HCV?80-100?2000?-4000?0.84%?-HCV?20?-40?2014?34?-HCV?6.59%?HCV?2.24?12%?100?-200?60?1?60?HCV?HCV?WHO?2?2017-2020?20?12?2/3?4?4?2016?8?8?2016?1?2016?12?HCV?61?467 008?HCV?50%?40?HCV?“?”?4?95%?“?”?3?2.3.2.2?-HCV?100%?HCV?62?HCV?HCV?HCV?2.3.3?2015?3?18?950?87%?93%?53%?41?-HCV?HCV?2011?5?5?“?”?517?“?”?58.6%?857?10.5%?63?48.3%?32.8%?2016?2011?2016?HCV RNA?HCV RNA?42?HCV RNA?HCV RNA?2.3.4?2.4?2017-2020?WS213-2018?2019?3?2019?SVR?12?24?64?DAA?2.4.1?-HCV?20?12?2/3?2017-2020?“?”?2015?53%?3.4%?43?2019?2?565?72.9%?13.2%44?65?2.4.2?DAA?2013?DAA?2019?1.3%45?-HCV?2018?5?9?14.6%?28/192?49?2?4.1%?46?2019?236?2.5%47?3?1?2?3?DAA?2016?66?2017?“?”?20%43?3.3?4.1?DAA?2015?DAA?2019?DAA?DAA?2019?67?2019?25?2.4.3 DAA?3?DAA?DAA?DAA?3?DAA?DAA?DAA?48?DAA?DAA?2017?4-12?25?3 222?217?DAA?DAA?DAA?46?DAA?3?DAA?DAA?2.4.4?68?“?”?“?”?DAA?4?1?2?3?4?2.5?2019?10?DAA?DAA?,?DAA?DAA?DAA?DAA?DAA?DAA?DAA?DAA?2019?3?DAA?69?2?1?2?2.5.1 DAA?DAA?2019?11?28?6?3?DAA?85%?3?12?60 000?6 600?89%?37 000?6 600?81%?70 000?13 000?81%?1b?1b?60%?1b?30%?1000-3000?2.5.2?DAA?2017-2020?“?”?70?1?2020?3?DAA?DAA?DAA?2020?1?1?4?1?DAA?DAA?DAA?DAA?DAA?2018?3?95%?10.3?76.5%?1 000-3 000?35%60%?3 000?55%?DAA?6 600?13 000?DAA?DAA?71?DAA?1 500?2 700?3 500?DAA?DAA?DAA?80%?DAA?12?SVR?DAA?DAA?DAA?DAA?DAA?DAA?2019?72?“?”?DAA?DAA?DAA?DAA?DAA?2.5.3 DAA?95%?DAA?3?1?2?3?4?3?DAA?2?1b?1b?400-1200?73?DAA?30%?2000-5000?DAA?80%?85%?“?”?DAA?2.5.4?DAA?DAA?1?2?3?2020?12 500?19 000?DAA?74?3?DAA?DAA?DAA?2030?DAA?3?2017-2020?3.1?75?11?2017-2020?2018?2018-2020?2019?2019-2022?1?2?3?4?DAA?4?3.1.1?4?“?.?”?2022?i?ii?70%?80%?90%?iii?50%?20%?iv?70%?76?4?4?4.5?12?10?90%?2019?4?12?SVR?90%?77?DAA?DAA?DAA?2019?8?DAA?DAA?DAA?-HCV?3.1.2?78?12?DAA?DAA?2022?3.1.3?79?1?“?”?“?”?WHO?“?”?2?DAA?3?4?80?3.2?DAA?3.2.1?1?-?-?-?-?81?2?HCV?3?2019?2020?82?3.3?DAA?2018?DAA?2?3?DAA?40 500?“?”?2018?4?1200?DAA?16?2018?2020?,?DAA?1b?12 500?1b?19 000?83?2018?“?”?DAA?DAA?DAA?DAA?1?2?4.?84?2016-2020?-?-?-?85?DAA?DAA?1?2?3?4?5?4.?“?2030”?86?87?“?”?“?”?1.?“?”?WHO?2020-2030?WHO?90%?65%?“?”?“?”?2.?88?4?3.?4.?895.?“?”?DAA?DAA?DAA?90Philip Sprading?2019?,Hepatitis C,Center for Disease Control and Prevention,United States.Retrieved from https:/wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-cUmar,Khan,et al?2017?,?2018?2017?Chen,Y.,Yu,C.,Yin,X.,Guo,X.,Wu,S.,&Hou,J.?2017?.Hepatitis C virus genotypes and subtypes circulating in Mainland China.Emerging microbes&infections,6?1?,1-7.?2019?2019?2019,13?1?1-18?2019?2019?2019,13?1?1-1866Country Dashboard?China?2019?,Polaris Observatory.CDA Foundation,retrieved from https:/cdafound.org/dashboard/polaris/dashboard.htmlChen G-F,Wei L,Chen J,Duan Z-P,Dou X-G,Xie Q,et al.?2016?Will Sofosbuvir/Ledipasvir?Harvoni?Be Cost-Effective and Affordable for Chinese Patients Infected with Hepatitis C Virus?An Economic Analysis Using Real-World Data.PLoS ONE 11?6?2018?2017?,?.?2005?.?.?23?5?,316-319?,?,?.?2018?/?1b?.?,18?12?.1352-1358?,?.?2019?.?-?.?14?7?.14-26?,?.?2018?.?.?,3.40-44?.?2018?.?J?.?21?6?,500-505?.?2019?,?.36?1?,33-51?.?2019?.?,11,38-44?.?2018?.?HTA?N.?,2018-08-16?F03?.?91Cooke,G.S.,Andrieux-Meyer,I.,Applegate,T.L.,Atun,R.,Burry,J.R.,Cheinquer,H.,.&Hamid,S.?2019?.Accelerating the elimination of viral hepatitis:a Lancet Gastroenterology&Hepatology Commission.The Lancet Gastroenterology&Hepatology,4?2?,135-184.Lanini,S.,Easterbrook,P.J.,Zumla,A.,&Ippolito,G.?2016?.Hepatitis C:global epidemiology and strategies for control.Clinical Microbiology and Infection,22?10?,833-838.Omran,D.,Alboraie,M.,Zayed,R.A.,Wifi,M.N.,Naguib,M.,Eltabbakh,M.,.&Saad,O.K.?2018?.Towards hepatitis C virus elimination:Egyptian experience,achievements and limitations.World Journal of Gastroenterology,24?38?,4330.Averhoff,F.,Lazarus,J.V.,Sergeenko,D.,Colombo,M.,Gamkrelidze,A.,Tsertsvadze,T.,.&Gnes,S.?2019?.Excellence in viral hepatitis eliminationLessons from Georgia.Journal of hepatology,71?4?,645-647.Frellick?2020?USPSTF Recommends HCV Screening for All US Adults Ages 18-79?Medscape.Coverage Guilde for Hepatitis C Screening,The AIDS Institute.Road to Elimination:Barriers and Best Practices in Hepatitis C Management,The Boston Consulting Group.Li M,Zhuang H,Wei L.How would China achieve WHOs target of eliminating HCV by 2030?Expert Rev Anti Infect Ther.2019 Oct;17(10):763-773.doi:10.1080/14787210.2019.1675509.Epub 2019 Oct 12.Bo Feng?Jin Zhang?Lai Wei.Inadequate awarenes of hepatitis C among nonspecialist physicians in ChinaJ.Advances in Medi-cal Education and Practice?2011?2:209-214.?,?,?,?,&?.?2013?.?29?2?:277-279.?2011?.?.?28?6?:332-334.?.?2013?29?12?:1500-1501.?.?2016?.?.?,17?5?,550-552.?.?2016?.?.?,17?5?,550-?92552.?,?,?,?,?,?,.&?.?2016?.?.?,23?5?,84-87.?,?,?,&?.?2016?.?HCV?.?,?5?,349-352.?,?,?,?,?,?,&?.?2018?.?.?,24?12?,1217-1220.?,?,?,?,?,?,.&?.?2015?.?.?,19?12?,1294-1295?,?,?,?,?,?,.&?.?2017?.?HCV?.?,34?2?,203-206.?,?,?,?,&?.?2010?.?.?,16?3?,273-276.?,?,?,?,&?.?2014?.?.?,29?7?,578-582.?,?,?,?,?,?,.&?.?2014?.2013?.?,29?7?,574-577.Liu,L.,Xu,H.,Hu,Y.,Shang,J.,Jiang,J.,Yu,L.,.&Li,W.?2019?.Hepatitis C screening in hospitals:find the missing patients.Virology journal,16?1?,47.2015?.2015?retrieved from http:/ from http:/ thesis,?.?