肝臟協會聯盟呼籲簡化C型肝炎治療
資料來源：Liz Highleyman/aidsmap news / 2019年11月13日/ 財團法人台灣紅絲帶基金會編譯
來自歐洲、美國、拉丁美洲和亞洲的肝臟疾病協會的領導人於本周在美國波士頓所舉行的肝臟會議上發出了全球行動呼籲，旨在朝著消除公共衛生上的威脅C型肝炎此一目標邁進。
根據主辦該會議的美國肝病研究協會（AASLD）的數據，全球大約有7,100萬人患有慢性C型肝炎（HCV），每年約有175萬人感染這種病毒。
2016年，世界衛生組織（WHO）成員國承諾消除病毒性肝炎，其目標包括到2030年要將B型和C型肝炎新感率降低80％，死亡率降低65％。研究顯示，這些目標是可以實現的，但是迄今為止，各國在邁向目標上取得了不同的成功。
該新聲明由美國肝病研究協會(AASLD)，歐洲肝病研究協會（EASL），拉丁美洲肝病研究協會（ALEH）和亞太肝病研究協會（APASL）的代表簽署。要求努力簡化HCV的測試和治療，以使其可用性更加地廣泛，尤其是在資源有限的環境中。
四個與克林頓醫療衛生計劃（CHAI）合作開展這項計劃的協會概述了實現這一目標的四種策略：
•簡化診斷和治療流程
•將C型肝炎治療整合納入初級保健和其他疾病的計劃中
•將HCV服務下放到地方
•與初級保健之臨床醫生和其他衛生保健從業者共同分擔任務。
由於該領域最新的進展，這些策略將成為可能，包括快速HCV抗體篩檢和可在門診單次就診時進行的確認性病毒載量測試，高效且耐受性良好的直接作用之抗病毒藥物（DAA），尤其最近，新的泛基因型口服小分子直接抗病毒藥物(direct antiviral agents, DAAs)，讓基因型測試不再需要。
AASLD在媒體聲明中說：「透過國家特定的部署和迅速擴大預防、篩檢和治療計畫，消除HCV是可能的」。「肝科醫生在擴大HCV照護上有關鍵角色，包括協助非專業人士進行之測試和C型肝炎治療，協助政府制定合理的測試和治療政策，以及在當地之聯盟中工作去解決測試和治療上之成本以及污名和歧視等方面之問題，不讓這些不需要的問題限制了許多人獲得救生之治療和被治癒的機會」。
在啟動該倡議的新聞發布會上，克林頓醫療衛生計劃（CHAI）執行副總裁David Ripin指出，我們可以藉由從全球對抗愛滋病毒中所汲取的經驗及教訓中獲得好處，這些包括簡化治療，分散照護體系以及與受影響的社區和有共同信念（即「患者擁有被診斷和治療的基本權利」）的倡導者合作等。他補充說，我們有必要「專注那些感覺良好，甚至從未聽說過肝炎的人」。
世界肝炎聯盟主席Michael Ninburg強調了讓臨床醫生和患者參與該計畫的重要性。他說：「在民間社會參與下，各國在應對病毒性肝炎方面做得更好」。「沒有人比患者更了解如何與疾病共存……當醫生和患者用統一的聲音時則其所表達之話語將更強烈」。
AASLD主席Michael Fried表示，該協會計劃在明年年底之前發布有關消除B型肝炎的類似文件。
Coalition of liver associations call for simplifying hepatitis C care
Liz Highleyman / 13 November 2019
Leaders of liver disease associations from Europe, the United States, Latin America and Asia issued a global call to action at the Liver Meeting this week in Boston, aiming to advance toward the goal of eliminating hepatitis C as a public health threat.
Approximately 71 million people worldwide have chronic hepatitis C virus (HCV), and around 1.75 million more acquire the virus annually, according to the American Association for the Study of Liver Diseases (AASLD), which sponsors the conference.
In 2016, World Health Organisation (WHO) member states committed to eliminating viral hepatitis, with targets including an 80% reduction in new hepatitis B and C infections and a 65% reduction in mortality by 2030. Studies have shown that these targets are achievable, but to date countries have had variable success in moving toward them.
The new statement, signed by representatives of AASLD, the European Association for the Study of the Liver (EASL), the Latin American Association for the Study of the Liver (ALEH) and the Asian Pacific Association for the Study of the Liver (APASL), calls for efforts to simplify HCV testing and treatment in order to make them more widely available, especially in resource-limited settings.
The four associations, which are undertaking this initiative in partnership with the Clinton Health Access Initiative (CHAI), outlined four strategies to achieve this goal:
•Simplifying diagnosis and treatment algorithms
•Integrating hepatitis C treatment into primary care and other disease programs
•Decentralizing HCV services to the local level
•Task-sharing with primary care clinicians and other health care practitioners.
These strategies are made possible by recent advances in the field, including rapid HCV antibody screening and confirmatory viral load testing that can be done at a single clinical visit, direct-acting antiviral agents (DAAs) that are highly effective and well tolerated and, most recently, new pan-genotypic DAAs that make genotypic testing unnecessary.
“HCV elimination is possible with country-specific deployment and rapid scale‐up of prevention, screening and treatment programs,” AASLD said in a media statement. “Hepatologists have key roles in expanding access to HCV care by helping non-specialists test and treat hepatitis C, assisting government in developing sound testing and treatment policies and working in local coalitions to address issues of testing and treatment costs, stigma and discrimination that unnecessarily limit access of many to life saving treatment and cure.”
At a press conference launching the initiative, CHAI executive vice president David Ripin noted that we can apply lessons learned from the global fight against HIV, including the benefits of simplifying treatment, decentralizing care, and working with affect communities and advocates who share the philosophy that “patients have a fundamental right to be diagnosed and treated.” He added that it will be necessary to “focus on people who are feeling fine and haven’t even heard of hepatitis.”
Michael Ninburg, president of the World Hepatitis Alliance, stressed the importance of involving both clinicians and patients in the initiative. “Countries do better at addressing viral hepatitis when civil society is engaged,” he said. “No one knows more about living with a disease than the patients…Doctors and patients speak more strongly with a united voice.”
AASLD president Michael Fried indicated that the associations plan to issue a similar document on hepatitis B elimination by the end of next year.