Global, regional, and national estimates of hepatitis C virus (HCV) infection incidence among people who inject drugs and number of new annual HCV infections attributable to injecting drug use: a multi-stage analysis.

We aimed to estimate HCV incidenceamong PWID before and since 2015, progress towards the 2030 target, and the number of new annual HCV infections attributable to injecting drug use since 2015.

我们的目标是估计2015年之前和之后PWID中HCV的发病率，朝着2030年目标的进展，以及自2015年以来归因于注射毒品使用的新的年度HCV感染数量。

Methods

Four sequential steps were taken to estimate country-specific HCV incidence.

我们采取了四个连续步骤来估计特定国家的HCV（丙型肝炎病毒）发病率。

First, we estimated HCV incidencefrom HCV antibody prevalenceby duration of injecting using force-of-infection (FOI) modelling.

首先，我们使用感染力模型（FOI）根据注射持续时间从HCV抗体阳性率估计HCV发病率。

Second, using Bayesian random-effects meta-analysis, we pooled FOI-derived estimates with any direct HCV incidenceestimates from a published global meta-analysis, by country.

其次，我们使用贝叶斯随机效应元分析，将FOI衍生的估计值与已发表的全球元分析中的任何直接HCV发病率估计值按国家进行合并。

Third, for countries with no FOI-derived or direct HCV incidencedata, we applied incidenceestimates from a published multi-country dynamic mathematical model.

第三，对于没有FOI衍生或直接HCV发病率数据的国家，我们采用了已发表的多国动态数学模型中的发病率估计值。

Fourth, for countries for which incidencecould not be estimated using any of the aforementioned methods but that had data on overall HCV antibody prevalence(ie, not stratified by duration of injecting), we used a regression model to predict incidencebased on prevalenceand average duration of injecting.

第四，对于无法使用前述任何方法估计发病率的国家，但有总体HCV抗体流行率数据（即未按注射时间长短进行分层），我们使用回归模型根据流行率和平均注射时间来预测发病率。

WHO regional and global HCV incidence, incidencerate ratios (IRRs) for 2015-21 versus pre-2015, and relative decline needed to achieve the 2030 WHO target were derived and weighted by the country-specific number of PWID at risk (ie, those who were HCV RNA-negative), provided that data from at least five countries were available within a WHO region.

WHO区域和全球的HCV发病率、2015-21年与2015年前的发病率比率（IRR）以及为实现2030年WHO目标所需的相对下降率，是根据每个国家特定的PWID风险人群数量（即HCV RNA阴性者）进行加权的，前提是该WHO区域内至少有五个国家的数据可用。

New annual HCV infections attributable to injecting drug use were estimated by multiplying country-specific HCV incidencefor the 2015-21 period by the number of HCV RNA-negative PWID; for countries with no HCV incidencedata but with evidence of an existing PWID population, incidencewas imputed using the corresponding WHO regional incidence.

通过将2015-21年期间各国特定的丙型肝炎（HCV）发病率乘以HCV RNA阴性的注射药物使用者（PWID）数量，估计了新的年度HCV感染病例，这些病例归因于注射药物使用；对于没有HCV发病率数据但有证据表明存在PWID人群的国家，使用相应WHO区域的发病率进行了推算。

Results

For the pre-2015 period, 146 HCV incidenceestimates from 81 countries were included: 52 (36%) direct, 61 (42%) FOI-derived, and 33 (23%) regression-based estimates.

对于2015年之前的时期，共纳入了来自81个国家的146个HCV发病率估计值：52个（36%）直接估计，61个（42%）基于首次感染机会（FOI）的估计，以及33个（23%）基于回归的估计。

For 2015-21, 114 estimates from 97 countries were included: 20 (18%) direct, 18 (16%) FOI-derived, 68 (60%) dynamic model-derived, and eight (7%) regression-based.

在2015-21年间，共纳入了来自97个国家的114个估计值：20个（18%）直接估计，18个（16%）基于感染率的估计，68个（60%）基于动态模型的估计，以及8个（7%）基于回归的方法。

Globally, pooled HCV incidencewas 13·9 per 100 person-years (95% uncertainty interval [UI] 11·9-16·4) for pre-2015 and 8·6 per 100 person-years (7·1-10·7) for 2015-21.

在全球范围内，综合的丙型肝炎病毒（HCV）发病率在2015年之前为每100人年13.9例（95%不确定性区间[UI] 11.9-16.4），而在2015-21年期间为每100人年8.6例（7.1-10.7）。

Based on a subset of countries with data for both periods, incidencewas lower in the Western Pacific (IRR 0·32 [95% UI 0·23-0·50]), Eastern Mediterranean (0·67 [0·50-0·89]), and European (0·79 [0·63-1·02]) regions in 2015-21 versus pre-2015, but no difference was observed in the Americas.

基于同时期有数据的国家子集，2015-21年期间，西太平洋地区（IRR 0·32 [95% UI 0·23-0·50]）、东地中海地区（0·67 [0·50-0·89]）和欧洲地区（0·79 [0·63-1·02]）的发病率低于2015年之前，但在美洲地区未观察到差异。

Insufficient data prevented comparisons over time for the African and South-East Asia regions and globally.

数据不足，无法对非洲和东南亚地区以及全球范围内进行时间上的比较。

Based on 2015-21 HCV incidence, the global decline needed to meet the 2030 WHO target is 76·7% (95% UI 71·8-81·3), while the global number of new annual HCV infections attributable to injecting drug use was 833 760 (95% UI 493 716-1 544 395) among the 187 countries with documented evidence of a population of PWID.

基于2015-21年丙型肝炎病毒（HCV）的发病率，全球需要下降76.7%（95% 不确定区间 71.8-81.3），才能达到2030年世界卫生组织的目标，而在有注射毒品使用者（PWID）人群证据的187个国家中，每年新发的HCV感染数量为833,760例（95% 不确定区间 493,716-1,544,395）。

interpretation

A substantial increase in HCV treatment and prevention is needed globally to achieve the WHO 2030 HCV elimination target for incidenceamong PWID.

为了实现2030年世界卫生组织关于注射毒品使用者中丙型肝炎病毒（HCV）发病率的消除目标，全球需要大幅增加HCV的治疗和预防工作。

funding

WHO and the Wellcome Trust.

世界卫生组织和韦尔科姆信托基金。