Hepatitis C virus (HCV) infection is one of the most prevalent health problems in the world. Official registration of HCV infections in the Russian Federation started in 1994. Two clinical forms of infection – acute and chronic hepatitis C – are registered separately. Moreover, the HCV national surveillance system also includes reports from laboratories on results from testing ∼20 population risk groups for antibodies to HCV; approximately 15–16 million tests are performed annually. Modern epidemiological features of HCV infection in the Russian Federation are characterized by low incidence of the acute form of infection (acute HCV; one to two per 100,000) and a dramatic increase in chronic HCV (CHCV) cases. In 2013, the average nationwide rate of newly detected CHCV cases was 39.3/100,000. In the same year, the prevalence of CHCV demonstrating an accumulation of chronically infected patients in the country was much higher – 335.8/100,000. Four risk groups were identified as greatly affected by HCV, which were demonstrated by a high prevalence of antibodies to HCV: newborns from chronically infected women, persons from correctional facilities, patients with chronic liver diseases, and clients from clinics for sexually transmitted disease patients and drug users. It was found that several HCV genotypes circulated in different regions of the country; HCV1b had a prevalence of 55%–80% in almost every part of the country. However, in St Petersburg during the final decade of the last century and from 2001–2005, HCV3a subtype expanded circulation among young people due to increased intravenous drug addiction. Intravenous drug users were the major cause of a higher registration of double infection, with two different virus subtypes, and the appearance in Russia of new recombinant virus RF_2k/1b. It can be concluded that CHCV infection should be a focus of the health care system in Russia because serious epidemics of liver cirrhosis and hepatocellular carcinoma will be seen in the near future that will require urgent preventive and therapeutic measures.
Резюме. С момента открытия вируса гепатита С в 1989 г. и официальной регистрации острых и хронических форм гепатита С (ГС) в Российской Федерации с 1994 г. накоплены многочисленные данные, дающие представления о развитии эпидемического процесса ГС в стране и особенностях эпидемиологии этой инфекции.
Background. In 2021, new clinical guidelines for the treatment of chronic hepatitis C virus (HCV) in adults were published that did not contain interferon drug therapy regimens. Current therapy of chronic HCV is based on modern drugs of direct-acting antivirals (DAA). In this regard, the model of diagnosis-related groups (DRG) with the use of interferon-containing drugs as etiotropic therapy, which has been in effect until now, has lost its relevance and cannot be used to pay for cases of medical care for chronic HCV within the framework of the Program of State Guarantees of Free Medical Care to Citizens for 2023 and for the planning period of 2024–2025 (PSG). Objective: to improve the DRG model to pay for medical care for chronic HCV in a day hospital based on current clinical recommendations.Material and methods. Regulatory legal documents on the subject of the study, proposals and expert opinions of specialists, as well as feedback from public organizations, including patients, regarding the payment of medical care for chronic HCV, sent as part of a public discussion of the draft PSG, were studied. For the calculations were used: the current version of the clinical recommendations "Chronic viral hepatitis C"; impersonal personalized information of the database of registers of bills for payment for medical care for 2020–2021; the state register of manufacturers' maximum selling prices for medicines included in the list of vital and essential drugs.Results. A DRG model was developed to pay for medical care during drug therapy of chronic HCV, including for children. When calculating the model, the cost of medicines, patient days and the principles of accounting for the duration of hospitalization were updated.Conclusion. The developed DRG model to pay for medical care for chronic HCV in a day hospital with the use of drug therapy regimens with DAA recommended by clinical guidelines, including for children with HCV, contributes to improving the effectiveness of the system of payment for medical care provided as part of the implementation of the PSG and accessibility of medical care for this contingent of patients.
The objective. To assess the dynamics of the epidemic process of chronic hepatitis C (CHC) in Russia and the Northwest Federal Region for the period 2015–2020. Materials and methods. The article analyzes the data from the state statistical reporting of infectious diseases in the Russian Federation (RF), from the reference-center for the monitoring of viral hepatitis, from statistical tables compiled at Methodological and Research Center for Epidemiological Surveillance of Viral Hepatitis under Pasteur Institute of Epidemiology and Microbiology. The data from the Federal register of patients with viral hepatitis were used.Results. The epidemiological indicators for 2020 should be interpreted taking into account the implementation of anti-epidemic measures for COVID-19 in the context of a pandemic. In 2015–2019, CHC incidence in the RF decreased by 18% (from 38o⁄oooo to 30,9o⁄oooo). For 2020 — by 46% (up to 16,7o⁄oooo). The total number of people with CHC is increasing (in 2015 — 562 622 people, in 2019 — 635 372). There is no clear downward trend in the dynamics of changes in the mortality rate from causes associated with HCV in the RF and the Northwestern Federal Region. The impact of the pandemic on mortality in HCV infection remains to be assessed. In 2019 in Russia, only 8,6% of patients on the register are covered by treatment. In 2020, according to preliminary data, treatment coverage was less than 1% of the estimated number of people with HCV infection (3 million). СHC incidence in the Northwest Federal Region decreased by less than 15% (48o⁄oooo — in 2019, 56,2o⁄oooo — in 2015), for 2020 — by 41% (up to 28,2o⁄oooo). Incidence is 1,5 times higher than in the RF on average. The total number of people with СHC is increasing (in 2015 — 92 780, in 2020 — 106 052). Few people with viral hepatitis know about their diagnosis (35% HCV-infected persons). Government funding for treatment has increased, but only 3% is covered by therapy. In the Northwestern Federal Region, as in the RF, the WHO strategy targets have not been achieved by 2020. The sharp decline in basic epidemiological indicators for 2020 is most likely due to a decrease in the number of patients seeking outpatient care and screening during the implementation of anti-epidemic measures for COVID-19.
Background. Five years have passed since the adoption of the strategy for the elimination of viral hepatitis. It is necessary to take stock of the frst results. Objective – to assess the dynamics of the epidemic process of CHC and the clinical manifestations of the disease during the period of 2015-2019. Material and methods. The article analyzes the data from the state statistical reporting of infectious diseases in the Russian Federation (RF), from the reference-center for the monitoring of viral hepatitis, from statistical tables compiled at Methodological and Research Center for Epidemiological Surveillance of Viral Hepatitis under Pasteur Institute of Epidemiology and Microbiology. The data from the Federal register of patients with viral hepatitis were used. The article analyzes our own experience of observing 555 patients with HCV at different stages of the disease. Results. In 2015–2019, CHC incidence in the RF decreased by 20% (30,90/0000- in 2019, 38,00/0000– in 2015). The total number of people with CHC is increasing (in 2015 – 562 622 people, in 2019 – 635372). It is estimated that only 20% of those infected are under surveillance. The death rate from CHC remains high. The proportion of patients with an advanced stage of CHC is about 20%. The proportion of decompensated cirrhosis decreased by 8%. In recent years, government funding for the treatment has increased, but only about 8% of all registered CHC patients are covered by the therapy. Conclusions. In the RF the WHO strategy targets have not been achieved by 2020. That’s why it’s important to develop a strategy to counter the spread of HCV for the period up to 2030.
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