Published in Journal Watch Gastroenterology May 10, 2013
Even with new treatments on the horizon for HCV infection, worldwide issues of access, cost, and gaps in physician knowledge must be addressed.
As we anticipate a new generation of treatments for hepatitis C virus (HCV) infection, it is important to view the global picture of HCV infection. The current companion studies estimate HCV seroprevalence and potential barriers to care worldwide.
To estimate global HCV seroprevalence, Mohd Hanafiah and colleagues conducted a meta-analysis of studies published between 1980 and 2007 that reported the prevalence of hepatitis B, C, and D virus infections. Researchers grouped countries into 21 epidemiologically homogenous regions. Overall, HCV seroprevalence increased from 2.3% to 2.8% from 1990 to 2005 (from >122 million to >185 million). The regions with the highest seroprevalence were North Africa/Middle East, Central Asia, and East Asia (>3.5%). The regions with the lowest seroprevalence were Asia Pacific, Tropical Latin America, and North America (<1.5%).
To understand physicians' perceived barriers to care, knowledge, and opinions, McGowan and colleagues surveyed 697 physicians from 29 countries. Overall, patient-level barriers were the most commonly cited (e.g., fear of side effects, cost of treatment); however, regional variation was noted (e.g., government-related barriers were cited most frequently in the Central/Eastern Europe region). Two thirds of physicians felt that patients did not have adequate access to providers in their communities. Globally, physicians demonstrated gaps in basic knowledge, such as the role of viral kinetics in treatment. Physicians with lower knowledge scores were more likely to perceive greater barriers to treatment versus physicians with higher scores (e.g., physicians in the Middle East/Africa region vs. those in the Nordic region).
Comment: These studies demonstrate that, globally, the seroprevalence of HCV infection is on the rise, especially in parts of the Middle East, Africa, and Asia. These same regions seem to have significant barriers to treatment, mainly at the patient level, such as side effects and cost, according to physicians. But gaps in physician knowledge are also a barrier. Although the coming generations of simpler, better-tolerated, shorter-duration treatments should eliminate some of these barriers, more work is needed to address access to care and cost of treatment, as well as awareness and education — not only for patients, but also providers.
Citation(s):
Mohd Hanafiah K et al. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013 Apr; 57:1333. (http://dx.doi.org/10.1002/hep.26141)
McGowan CE at al. A global view of hepatitis C: Physician knowledge, opinions, and perceived barriers to care. Hepatology 2013 Apr; 57:1325. (http://dx.doi.org/10.1002/hep.26246)
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