Introduction:Current strategies for chronic viral hepatitis prevention and control include immunization,prevention of mother-to-child transmission,expanded testing,antiviral therapy,and national drug price negotiation...Introduction:Current strategies for chronic viral hepatitis prevention and control include immunization,prevention of mother-to-child transmission,expanded testing,antiviral therapy,and national drug price negotiations.To achieve this effectively,Shanghai has implemented a communitybased pilot program that integrates public health and clinical care for chronic viral hepatitis management.Methods:This study evaluated the effectiveness of Shanghai’s community-based healthcare program at three time points(2012,2019,and 2023),assessing key indicators including antiviral treatment rates and disease status changes and risk of hepatocellular carcinoma.Data were managed using EpiData 3.1,with descriptive statistics and chi-square tests performed using SPSS 29.0.Results:The study enrolled 1,478,1,901,and 7,714 patients in 2012,2019,and 2023,respectively.During the management period,the number of enrolled patients increased substantially from baseline.The antiviral treatment rates in 2019 and 2023 reached 64.5%and 58.2%,with both significantly higher than the baseline rate of 24.5%in 2012.Concurrently,abnormality rates for hepatitis B virus deoxyribonucleic acid(HBV DNA),alanine aminotransferase(ALT),total bilirubin(TBIL),and fibrosis indices decreased significantly in 2019 and 2023.The 2023 aMAP score further revealed a decline in hepatocellular carcinoma risk among managed patients(32.2%vs.26.3%).With enhanced community healthcare capacity,14.1%(2019)and 18.2%(2023)of patients accessed community dispensing services,aligning with the strategy to decentralize testing and treatment for disease elimination.Conclusions:Community-based healthcare management for chronic hepatitis in Shanghai provides patients with decentralized hepatitis-related testing and treatment services,creating an effective environment for chronic viral hepatitis prevention and control and would favorable for the viral hepatitis elimination efforts.展开更多
Background Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination eforts in endemic areas of Africa.Build‑i...Background Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination eforts in endemic areas of Africa.Build‑ing on a previous China-UK-Tanzania pilot study on malaria control,this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response(1,7-mRCTR)approach implemented over two years in three districts of Tanzania.Methods The 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treat‑ment in villages with the highest burden of malaria incidence based on surveillance data from health facilities.We used a diference-in-diferences quasi-experimental design with linear probability models and two waves of crosssectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence.We conducted sensitivity analyses to assess the robustness of our results,examined how intervention efects varied in subgroups,and explored alternative explanations for the observed results.Results Between October 2019 and September 2021,244,771 community-based malaria rapid tests were com‑pleted in intervention areas,and each intervention village received an average of 3.85 rounds of 1-7mRCTR.Malaria prevalence declined from 27.4%at baseline to 11.7%at endline in the intervention areas and from 26.0%to 16.0%in the control areas.1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence(95%confdence interval:−0.067,−0.023),equivalent to a 17%reduction from the baseline.In Rufji,a district characterized by lower prevalence and where larviciding was additionally provided,1,7-mRCTR was associated with a 63.9%decline in malaria prevalence.Conclusions The 1,7-mRCTR approach reduced malaria prevalence.Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges,the study provided novel evidence on the efectiveness of community-based reactive approaches in moderate-to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges.展开更多
基金Supported by the Shanghai Three-year Action Plan to Strengthen the Public Health System(Grant No.GWVI-9)the Shanghai Municipal Health Commission Youth Project(Grant No.20224Y0333).
文摘Introduction:Current strategies for chronic viral hepatitis prevention and control include immunization,prevention of mother-to-child transmission,expanded testing,antiviral therapy,and national drug price negotiations.To achieve this effectively,Shanghai has implemented a communitybased pilot program that integrates public health and clinical care for chronic viral hepatitis management.Methods:This study evaluated the effectiveness of Shanghai’s community-based healthcare program at three time points(2012,2019,and 2023),assessing key indicators including antiviral treatment rates and disease status changes and risk of hepatocellular carcinoma.Data were managed using EpiData 3.1,with descriptive statistics and chi-square tests performed using SPSS 29.0.Results:The study enrolled 1,478,1,901,and 7,714 patients in 2012,2019,and 2023,respectively.During the management period,the number of enrolled patients increased substantially from baseline.The antiviral treatment rates in 2019 and 2023 reached 64.5%and 58.2%,with both significantly higher than the baseline rate of 24.5%in 2012.Concurrently,abnormality rates for hepatitis B virus deoxyribonucleic acid(HBV DNA),alanine aminotransferase(ALT),total bilirubin(TBIL),and fibrosis indices decreased significantly in 2019 and 2023.The 2023 aMAP score further revealed a decline in hepatocellular carcinoma risk among managed patients(32.2%vs.26.3%).With enhanced community healthcare capacity,14.1%(2019)and 18.2%(2023)of patients accessed community dispensing services,aligning with the strategy to decentralize testing and treatment for disease elimination.Conclusions:Community-based healthcare management for chronic hepatitis in Shanghai provides patients with decentralized hepatitis-related testing and treatment services,creating an effective environment for chronic viral hepatitis prevention and control and would favorable for the viral hepatitis elimination efforts.
基金supported by Bill&Melinda Gates Foundation(OPP1198779 and OPP1213975).
文摘Background Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination eforts in endemic areas of Africa.Build‑ing on a previous China-UK-Tanzania pilot study on malaria control,this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response(1,7-mRCTR)approach implemented over two years in three districts of Tanzania.Methods The 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treat‑ment in villages with the highest burden of malaria incidence based on surveillance data from health facilities.We used a diference-in-diferences quasi-experimental design with linear probability models and two waves of crosssectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence.We conducted sensitivity analyses to assess the robustness of our results,examined how intervention efects varied in subgroups,and explored alternative explanations for the observed results.Results Between October 2019 and September 2021,244,771 community-based malaria rapid tests were com‑pleted in intervention areas,and each intervention village received an average of 3.85 rounds of 1-7mRCTR.Malaria prevalence declined from 27.4%at baseline to 11.7%at endline in the intervention areas and from 26.0%to 16.0%in the control areas.1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence(95%confdence interval:−0.067,−0.023),equivalent to a 17%reduction from the baseline.In Rufji,a district characterized by lower prevalence and where larviciding was additionally provided,1,7-mRCTR was associated with a 63.9%decline in malaria prevalence.Conclusions The 1,7-mRCTR approach reduced malaria prevalence.Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges,the study provided novel evidence on the efectiveness of community-based reactive approaches in moderate-to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges.
