1
|
Palladino C, Ramis R, Ezeonwumelu IJ, Biondi A, Carreras G, Fischer F, Gallus S, Golinelli D, Gorini G, Hassan S, Kabir Z, Koyanagi A, Lazarus JV, Mentis AFA, Meretoja TJ, Mokdad AH, Monasta L, Mulita F, Postma MJ, Tabarés-Seisdedos R, Thiyagarajan A, Taveira N, Briz V. Impact of the 2008 economic crisis on the burden of hepatitis B and C diseases in Southern European countries. BMC Public Health 2024; 24:1642. [PMID: 38902642 PMCID: PMC11188182 DOI: 10.1186/s12889-024-18912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may have affected ongoing efforts to eliminate viral hepatitis. This study was conducted to investigate the impact of the economic crisis on the burden of HBV and HCV disease. METHODS Global Burden of Diseases 2019 data were used to analyse the rates of epidemiological metrics of HBV and HCV acute and chronic infections in SWE and WE. Time series modelling was performed to quantify the impact of healthcare expenditure on the time trend of HBV and HCV disease burden in 2000-2019. RESULTS Declining trends in incidence and prevalence rates of acute HBV (aHBV) and chronic HBV were observed in SWE and WE, with the pace of decline being slower in the post-austerity period (2010-2019) and mortality due to HBV stabilised in SWE. Acute HCV (aHCV) metrics and chronic HCV incidence and mortality showed a stable trend in SWE and WE, whereas the prevalence of chronic HCV showed an oscillating trend, decreasing in WE in 2010-2019 (p < 0.001). Liver cancer due to both hepatitis infections showed a stagnant burden over time. An inverse association was observed between health expenditure and metrics of both acute and chronic HBV and HCV. CONCLUSIONS Epidemiological metrics for HBV and HCV showed a slower pace of decline in the post-austerity period with better improvement for HBV, a stabilisation of mortality and a stagnant burden for liver cancer due to both hepatitis infections. The economic crisis of 2008 had a negative impact on the burden of hepatitis B and C. Elimination of HBV and HCV by 2030 will be a major challenge in the SWE countries.
Collapse
Affiliation(s)
- Claudia Palladino
- Research Institute for Medicines, Faculty of Pharmacy, Universidade de Lisboa, Avenida Professor Gama Pinto, Lisbon, 1649-003, Portugal.
| | - Rebeca Ramis
- Nacional Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Ifeanyi Jude Ezeonwumelu
- Institute for Health Science Research Germans Trias I Pujol, Autonomous University of Barcelona, Badalona, Spain
- IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Giulia Carreras
- Institute for Cancer Research, Prevention, and Clinical Network, Florence, Italy
| | - Florian Fischer
- Institute of Public Health, Charité Universitätsmedizin Berlin, Charité Medical University Berlin), Berlin, Germany
| | - Silvano Gallus
- Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Mario, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Gorini
- Oncological Network, Prevention and Research Institute, Institute for Cancer Research, Prevention, and Clinical Network, Florence, Italy
| | - Shoaib Hassan
- Center for International Health (CIH), University of Bergen, Bergen, Norway
- Bergen Center for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
| | - Zubair Kabir
- School of Public Health, University College Cork, Cork, Ireland
| | - Ai Koyanagi
- San Juan de Dios Sanitary Park, Barcelona, Spain
| | | | | | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
- Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Maarten J Postma
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia, Valencia, Spain
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
| | - Arulmani Thiyagarajan
- Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Nuno Taveira
- University Institute "Egas Moniz", Monte da Caparica, Portugal
- Research Institute for Medicines, University of Lisbon, Lisbon, Portugal
| | - Verónica Briz
- Laboratory of Viral Hepatitis, National Center of Microbiology, Institute of Health Carlos III, Carretera Majadahonda-Pozuelo Km 2.2, 28220, Majadahonda, Madrid, Spain.
| |
Collapse
|
2
|
Chang HY, Wang SH, Kuo HT, Sheu MJ, Feng IC, Ho CH, Chen JY, Sun CS, Chen CH, Lin CY, Yang CC. The Efficacy of On-Site Integration Screening and Microelimination Programs for Chronic Hepatitis C in a Detection Center: A Comparison of the Treatment Outcomes and Characteristics of Incarcerated Patients and Outpatients. Int J Hepatol 2024; 2024:3184892. [PMID: 38510786 PMCID: PMC10954363 DOI: 10.1155/2024/3184892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
We aimed to analyze the different patient characteristics and treatment outcomes (such as sustained viral response, SVR) between incarcerated patients with chronic hepatitis C (CHC) and those with CHC from the outpatient department through an on-site integrated screening and microelimination program in a detection center. In this retrospective study, which ran from May 2021 to April 2022, we included 32 consenting male prisoners aged at least 20 years who were willing to participate in the study. Members of the control group (who received DAAs in an outpatient setting) were selected from the treated CHC patient databank of individuals who received DAA regimens at Chi Mei Hospital between January 2021 and December 2022. The patients in the two groups did not differ significantly in terms of age, FIB-4 score, HCV RNA, HBV coinfection, hemogram findings, coagulation profiles, and renal function tests. However, the patients in the incarcerated group had a significantly different genotype distribution compared to the control group, significantly lower liver enzyme levels, and higher albumin and bilirubin levels compared to those in the control group. The rate of SVR to DAA treatment obtained among incarcerated patients did not differ significantly from that obtained among patients in the control group. Loss to follow-up (for several reasons) is a major reason for treatment discontinuation among these patients.
Collapse
Affiliation(s)
- Hsuan-Yuan Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Su-Hung Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ming-Jen Sheu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - I-Che Feng
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chi-Shu Sun
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chi-Hsing Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Yi Lin
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Chi Yang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| |
Collapse
|
3
|
Piselli P, Boschini A, Gianfreda R, Nappo A, Cimaglia C, Scarfò G, Smacchia C, Paoletti R, Duehren S, Girardi E. Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience. Viruses 2024; 16:375. [PMID: 38543741 PMCID: PMC10974793 DOI: 10.3390/v16030375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 05/23/2024] Open
Abstract
Injection drug use represents an important contributor to hepatitis C virus (HCV) transmission, hence therapeutic communities (TCs) are promising points of care for the identification and treatment of HCV-infected persons who inject drugs (PWIDs). We evaluated the effectiveness and efficacy of an HCV micro-elimination program targeting PWIDs in the context of a drug-free TC; we applied the cascade of care (CoC) evaluation by calculating frequencies of infection diagnosis, confirmation, treatment and achievement of a sustained virological response (SVR). We also evaluated the risk of reinfection of PWIDs achieving HCV eradication by collecting follow-up virologic information of previously recovered individuals and eventual relapse in drug use, assuming the latter as a potential source of reinfection. We considered 811 PWIDs (aged 18+ years) residing in San Patrignano TC at the beginning of the observation period (January 2018-March 2022) or admitted thereafter, assessing for HCV and HIV serology and viral load by standard laboratory procedures. Ongoing infections were treated with direct-acting antivirals (DAA), according to the current national guidelines. Out of the 792 individuals tested on admission, 503 (63.5%) were found to be seropositive for antibodies against HCV. A total of 481 of these 503 individuals (95.6%) underwent HCV RNA testing. Out of the 331 participants positive for HCV RNA, 225 were ultimately prescribed a DAA treatment with a sustained viral response (SVR), which was achieved by 222 PWIDs (98.7%). Of the 222 PWIDs, 186 (83.8%) with SVR remained HCV-free on follow-up (with a median follow-up of 2.73 years after SVR ascertainment). The CoC model in our TC proved efficient in implementing HCV micro-elimination, as well as in preventing reinfection and promoting retention in the care of individuals, which aligns with the therapeutic goals of addiction treatment.
Collapse
Affiliation(s)
- Pierluca Piselli
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Antonio Boschini
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Romina Gianfreda
- Infectious Disease Unit, Hospital of Rimini “Gli Infermi”, 47923 Rimini, Italy;
| | - Alessandra Nappo
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Claudia Cimaglia
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Gianpaolo Scarfò
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Camillo Smacchia
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Raffaella Paoletti
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Sarah Duehren
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Enrico Girardi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| |
Collapse
|
4
|
Tai CM, Yu ML. Hepatitis C virus micro-elimination in people who inject drugs: Challenges and chance in Taiwan and worldwide. Kaohsiung J Med Sci 2024; 40:112-118. [PMID: 38010851 DOI: 10.1002/kjm2.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
With the introduction of direct-acting antivirals, elimination of hepatitis C virus (HCV) infection is becoming possible. People who inject drugs (PWID) represent a population with a high risk for HCV infection, which has been reported as high as 90% in Taiwanese PWID. To reach the goal of HCV elimination, PWID is a key population deserving special attention. Barriers in HCV care cascade still exist in PWID, and interventions to promote access to HCV diagnosis, link-to-care, treatment, and prevention for PWID are warranted. Although HCV micro-elimination can be achieved in some prisons and opioid substitution therapy (OST) centers by a multidisciplinary team and integrated care in Taiwan, there are still several unmet needs for HCV elimination in PWID. Continuous efforts, such as the participation of OST specialists and the continuum of care for HCV among PWID, are needed to achieve HCV elimination in Taiwan. In addition, the combination of harm reduction services, treatment as prevention and regular posttreatment HCV surveillance is critical to substantially reduce HCV transmission and prevalence in PWID.
Collapse
Affiliation(s)
- Chi-Ming Tai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
5
|
Cambianica A, Marchese V, Pennati F, Faustinelli A, Migliorati M, Roda F, Spinetti A, Zaltron S, Fiorentini S, Caruso A, Quiros-Roldan E, Castelli F, Focà E. Chronic Hepatitis C Cascade of Care in Prisoners-Is There Still Some Work to Do? Analysis of Two Large Penitentiaries in Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:104. [PMID: 38248566 PMCID: PMC10815604 DOI: 10.3390/ijerph21010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
Penitentiaries have a higher burden of communicable diseases compared to the general population. Prisoners should be tested for hepatitis C virus (HCV) and have direct access to treatment. We analysed the HCV cascade of care in two penitentiaries in Brescia, Northern Italy. At admission, prisoners are offered a voluntary screening for HCV, while patients with known infections are tested with an HCVRNA measurement. We performed an observational retrospective study including all the subjects admitted to the penitentiaries from 1 January 2015 to 31 October 2021. We conducted a descriptive analysis. During the study period, 5378 admissions were registered, and 2932 (54.5%) screenings were performed. Hepatitis C virus antibody positivity was found in 269 tests (9.2%). Hepatitis C virus RNA was detectable in 169 people. During the study period, 77 treatments with direct-acting antivirals (DAAs) were administered. Follow-up was available in 45 patients, and sustained virological response (SVR) was documented in 44 of them. Retention in care occurred in less than half of the prisoners after release. Our data demonstrate poor screening adherence that could benefit from educational programs. Treatment rates could be improved with test-and-treat programs. More efforts are needed to eliminate HCV as a public threat by 2030. Dedicated local networks, including infectious diseases (ID) departments, substance abuse services and prisons, could mitigate these issues.
Collapse
Affiliation(s)
- Anna Cambianica
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Francesca Pennati
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Alessandro Faustinelli
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Manuela Migliorati
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Fabio Roda
- Unit of Prison Health, ASST Spedali Civili Hospital, 25123 Brescia, Italy;
| | - Angiola Spinetti
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Serena Zaltron
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Simona Fiorentini
- Unit of Microbiology and Virology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (S.F.); (A.C.)
| | - Arnaldo Caruso
- Unit of Microbiology and Virology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (S.F.); (A.C.)
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Emanuele Focà
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| |
Collapse
|
6
|
Mongale E, Allen S, Brew I, Ludlow-Rhodes A, Royal N, Waldron J, Alexander H, Christensen L, Dorrington K, Milner A, Missen L, Jones A, Troke PJ. Development and optimisation of a reception testing protocol designed to eliminate HCV in the UK prison population. JHEP Rep 2024; 6:100937. [PMID: 38169900 PMCID: PMC10758963 DOI: 10.1016/j.jhepr.2023.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 01/05/2024] Open
Abstract
Background & Aims Micro-elimination of hepatitis C virus (HCV) in high-risk populations is a feasible approach towards achieving the World Health Organization's targets for viral hepatitis elimination by 2030. Prisons represent an area of high HCV prevalence and so initiatives that improve testing and treatment of residents are needed to eliminate HCV from prisons. This initiative aimed to improve the HCV screening and treatment rates of new residents arriving at prisons in England. Methods A rapid test and treat pathway was developed and implemented in 47 prisons in England between May 2019 and October 2021 as a healthcare service improvement initiative. Prison healthcare staff performed opt-out HCV testing for all new residents at each prison within 7 days of arrival, and those who were positive for HCV RNA were offered treatment with direct-acting antivirals (DAAs). The Hepatitis C Trust provided peer support for all residents on treatment and those who were released into the community. Results Of 107,260 new arrivals, 98,882 (92.2%) were offered HCV antibody testing, 63,137 (63.9%) were tested and 1,848 were treated. Testing rates increased from 53.7% in Year 1 to 86.0% in Year 3. Between May 2020 and October 2021, 40,727 residents were tested, 2,286 residents were positive for HCV antibodies and 940 residents were HCV RNA positive, giving an antibody prevalence of 5.6% and an RNA prevalence of 2.3%. A total of 921 residents were referred for treatment and 915 initiated DAA treatment (97.3% of whom were HCV RNA positive). Conclusions This initiative showed that an opt-out HCV test and treat initiative in prison receptions is feasible and can be adapted to the needs of individual prisons as a viable way to achieve HCV micro-elimination. Impact and implications Prisons represent an area of high HCV prevalence and so initiatives that improve testing and treatment of residents are needed to eliminate HCV from prisons. The reception testing protocol improved HCV screening in new arrivals across 47 prisons in England and could be a viable way for countries to achieve HCV micro-elimination in their prison systems. The reception testing protocol presented here can be adapted to the individual needs of prisons, globally, to improve HCV screening and treatment in this setting.
Collapse
Affiliation(s)
- Emily Mongale
- Practice Plus Group, 5–6 Napier Court, Napier Road, Berkshire RG1 8BW, UK
| | - Samantha Allen
- Practice Plus Group, 5–6 Napier Court, Napier Road, Berkshire RG1 8BW, UK
| | - Iain Brew
- Practice Plus Group, 5–6 Napier Court, Napier Road, Berkshire RG1 8BW, UK
| | | | - Nichola Royal
- Practice Plus Group, 5–6 Napier Court, Napier Road, Berkshire RG1 8BW, UK
| | - Julia Waldron
- Practice Plus Group, 5–6 Napier Court, Napier Road, Berkshire RG1 8BW, UK
| | - Hannah Alexander
- Practice Plus Group, 5–6 Napier Court, Napier Road, Berkshire RG1 8BW, UK
- Defence Primary Healthcare, UK
| | | | | | - Andrew Milner
- Gilead Sciences Ltd, 280 High Holborn, London WC1V 7EE, UK
| | - Louise Missen
- Gilead Sciences Ltd, 280 High Holborn, London WC1V 7EE, UK
| | - Andy Jones
- Gilead Sciences Ltd, 280 High Holborn, London WC1V 7EE, UK
| | | |
Collapse
|
7
|
Fiore V, De Vito A, Rastrelli E, Manca V, De Matteis G, Ranieri R, Pontali E, Geremia N, Panese S, Starnini G, Madeddu G, Babudieri S. Differences in HCV Seroprevalence, Clinical Features, and Treatment Outcomes between Female and Male Incarcerated Population: Results from a Matched Cohort Study. Viruses 2023; 15:2414. [PMID: 38140655 PMCID: PMC10747283 DOI: 10.3390/v15122414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Women represent less than 5% of the incarcerated population in Italy, with very limited data on HCV infection. Higher HCV seroprevalence and active infection rates have been described among incarcerated females in available studies. Our aim is to compare the prevalence and cascade of care of HCV between male and female populations in Italian penitentiaries. METHODS We conducted a multicentre, retrospective study comparing HCV seroprevalence, active infections, treatment, and SVR rates between female (Group A) and male (Group B) populations in Italian prison settings. RESULTS No significant differences were found between the two groups regarding PWIDs (p = 0.16), nor in people living with HIV (p = 0.35) or HBV co-infection (p = 0.36). HCV seroprevalence was higher in Group A (p = 0.002). There was no statistically significant difference between the two groups regarding active infections (p = 0.41). Both groups showed a low level of fibrosis, and the dominant genotype was 3a. Almost all patients underwent antiviral treatment. All treated patients achieved SVR12. CONCLUSIONS Our findings illuminate the importance of recognizing and addressing gender differences in HCV seroprevalence within penitentiary settings. Moving forward, addressing the unique needs of incarcerated females and optimizing HCV care for all incarcerated individuals are essential steps in the pursuit of achieving HCV micro-elimination goals.
Collapse
Affiliation(s)
- Vito Fiore
- Unit of Infectious Diseases, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.D.V.); (V.M.); (G.M.); (S.B.)
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.D.V.); (V.M.); (G.M.); (S.B.)
- PhD School in Biomedical Science, Biomedical Science Department, University of Sassari, 07100 Sassari, Italy
| | - Elena Rastrelli
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, 01100 Viterbo, Italy; (E.R.); (G.S.)
| | - Valentina Manca
- Unit of Infectious Diseases, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.D.V.); (V.M.); (G.M.); (S.B.)
| | - Giuseppe De Matteis
- Health Protection for Adults and Youth Unit, Penitentiary Institute, 84124 Salerno, Italy;
| | - Roberto Ranieri
- Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, 20122 Milan, Italy;
| | | | - Nicholas Geremia
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Dell’Angelo, 30174 Venice, Italy; (N.G.); (S.P.)
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Civile “S.S. Giovanni e Paolo”, 30122 Venice, Italy
| | - Sandro Panese
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Dell’Angelo, 30174 Venice, Italy; (N.G.); (S.P.)
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Civile “S.S. Giovanni e Paolo”, 30122 Venice, Italy
| | - Giulio Starnini
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, 01100 Viterbo, Italy; (E.R.); (G.S.)
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.D.V.); (V.M.); (G.M.); (S.B.)
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.D.V.); (V.M.); (G.M.); (S.B.)
| |
Collapse
|
8
|
Johnson A, Shearer J, Thompson C, Jelley R, Aldridge J, Allsop C, Kerry J, Jones D, McCullough F, Miller C, Valappil M, Taha Y, Masson S, Jefferson T, Lawton C, Christensen L, McPherson S. Impact of 5 years of hepatitis C testing and treatment in the North East of England prisons. J Viral Hepat 2023; 30:914-921. [PMID: 37700492 DOI: 10.1111/jvh.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/25/2023] [Accepted: 09/02/2023] [Indexed: 09/14/2023]
Abstract
Hepatitis C virus infection (HCV) is prevalent in prisons. Therefore, effective prison HCV services are critical for HCV elimination programmes. We aimed to evaluate the efficacy of a regional HCV prison testing and treatment programme. Between July 2017 and June 2022, data were collected prospectively on HCV test offer and uptake rates, HCV Antibody (HCV-Ab) and HCV-RNA positivity, treatment starts and outcomes for new inmates incarcerated in three prisons. Rates of HCV-Ab and RNA positivity at reception, incidence of new HCV infections and reinfection following treatment were determined. From a total of 39,652 receptions, 33,028 (83.3%) were offered HCV testing and 20,394 (61.7%) completed testing. Including all receptions, 24.5% of tests (n = 4995) were HCV-Ab positive and 8.4% of tests (n = 1713) were HCV-RNA positive. When considering the first test for each individual (median age 34 years; 88.1% male), 14.8% (n = 1869) and 7.2% (n = 905) were HCV-Ab and HCV-RNA positive, respectively. The incidence of new HCV-Ab and RNA positivity was 5.1 and 3.3 per 100 person-years, respectively. Of 1145 HCV viraemic individuals, 18 died within 6 months and 150 were rapidly transferred out of area, leaving 977 individuals with outcomes. Of these, 835 (85.5%) received antivirals and 47 spontaneously cleared the infection, leaving 95 (9.7%) untreated. 607 (72.7%) achieved SVR. 95 patients had reinfection post-treatment (rate 10.1 cases per 100 person-years). Testing for HCV has increased in our prisons and the majority with viraemia are initiated on antiviral treatment. Reassuringly, a significant fall in frequency of HCV-RNA positivity at prison reception was observed suggesting progress towards HCV elimination.
Collapse
Affiliation(s)
- Amy Johnson
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jessica Shearer
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Ryan Jelley
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Caroline Allsop
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jenna Kerry
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dee Jones
- Spectrum Community Health, Wakefield, UK
| | - Francesca McCullough
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Carolyn Miller
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Manoj Valappil
- Department of Microbiology and Virology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yusri Taha
- Department of Microbiology and Virology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Steven Masson
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Stuart McPherson
- Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
9
|
Torre P, Coppola R, Masarone M, Persico M. Country-Wide HCV Elimination Strategies Need to Reach Older Patients in the General Population: The Italian Experience. Viruses 2023; 15:2199. [PMID: 38005877 PMCID: PMC10674437 DOI: 10.3390/v15112199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
HCV infection is still a major burden worldwide, and most countries are not on track to meet the WHO 2030 elimination goal. The current challenge is to identify individuals to be treated. In this study, we will describe the trend of new DAA prescriptions and the changes over time in terms of the characteristics of patients starting antiviral therapy in our unit. Data of 1646 hepatitis C patients who started therapy during the period of 2015-2022 regarding annual number of prescriptions, age, gender, nationality, HCV genotype, provenance, and liver disease severity were analyzed. We observed a peak in the number of new prescriptions in 2018 and a downward trend starting in 2019. Patients from the general population, centers for addictions, and prison differed significantly. The mean age in the general population remained above 60 years, the percentage of patients from centers for addictions and prison increased and, after 2016, there was no significant change in the percentage of patients with F3-F4 fibrosis. As HCV screening and linkage-to-care pathways seem to be already well implemented and successful in centers for addictions and in prisons, efforts need to be focused on those of older age in the general population. To carry this out, the more structured involvement of different health professionals must be figured out.
Collapse
Affiliation(s)
| | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Città d’Ippocrate, 84131 Salerno, Italy; (P.T.); (R.C.); (M.M.)
| |
Collapse
|
10
|
Kondili LA, Craxì L, Nava F, Babudieri S, D'Ambrosio R, Marcellusi A, Mennini FS, Valle S, Russo P, Olimpieri PP, Andreoni M, Aghemo A. From Prioritization to Universal Treatment: Successes and Challenges of Hepatitis C Virus Elimination in Italy. J Infect Dis 2023; 228:S211-S220. [PMID: 37703346 DOI: 10.1093/infdis/jiad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Italy has had the highest prevalence of hepatitis C virus (HCV) infection and mortality from HCV-related liver cancer in Europe. Although direct-acting antivirals (DAA) were initially restricted to persons with advanced fibrosis, their use has since been extended to all infected individuals; more than 244 000 persons have been treated to date. HCV liver-related mortality is expected to decline by 75% by 2030, achieving the World Health Organization target for mortality. However, Italy risks failing to meet the overall goal of eliminating HCV infection by 2030. In this light, €71.5 million have been allocated for screening initially specific target populations (persons who inject drugs, prison inmates, and the 1969-1989 birth cohort). Herein, we outline the challenges and recommendations for how to move Italy toward HCV elimination, including expanding screening programs in other populations, increasing awareness through strategic communication, sustaining DAA access, and tailoring care models to meet the needs of key populations.
Collapse
Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanita, Rome, Italy
- Degree Course in Dentistry and Dental Prosthetics, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Lucia Craxì
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Felice Nava
- Health Care and Drug Abuse Unit in Prison, Public Health Agency, Padua, Italy
- Federazione Italiana degli Operatori dei Dipartimenti e dei Servizi delle Dipendenze, Milan, Italy
| | - Sergio Babudieri
- Infectious and Tropical Disease Unit, University Hospital of Sassari, Sassari, Italy
- Italian Society of Penitentiary Health Medicine, Viterbo, Italy
| | - Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Marcellusi
- Economic Evaluation and Health Technology Assessment, Centre for Economic and International Studies, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and Health Technology Assessment, Centre for Economic and International Studies, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
- Institute of Leadership and Management in Health, Kingston Business School, Kingston University, London, United Kingdom
- Italian Society of Health Technology Assessment, Rome, Italy
| | - Sabrina Valle
- General Directorate for Health Prevention, Prevention of Communicable Diseases and International Prophylaxis, Italian Ministry of Health, Rome, Italy
| | - Pierluigi Russo
- Health Economic Evaluations Office, Italian Medicines Agency, Rome, Italy
- Monitoring Registers Office, Italian Medicines Agency, Rome, Italy
| | | | - Massimo Andreoni
- Infectious Diseases Clinic, University Hospital Tor Vergata, Rome, Italy
- Italian Society of Infectious and Tropical Diseases, Prato, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Isituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, 20089, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Italian Association for the Study of the Liver, Rome, Italy
| |
Collapse
|
11
|
Lo CC, Lei WY, Huang YC, Hwang JJ, Lo CY, Lin CH, Cheng HS, Liao YT, Liang PC, Chiou MJ, Bair MJ, Dai CY, Yu ML. Micro-elimination of hepatitis C virus infection in the rural and remote areas of Taiwan - A multi-center collaborative care model. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:680-687. [PMID: 36822945 DOI: 10.1016/j.jmii.2023.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Taiwan has several hepatitis C virus (HCV) hyper-endemic areas. We aimed to evaluate the effectiveness and safety of a collaborative HCV care system with an outreach decentralized strategy among the resource-constrained rural/remote areas of Taiwan. METHODS The pilot study was conducted in four high HCV-endemic townships in the rural/remote areas of Taoyuan, Alishan, Zhuoxi and Xiulin. Registered residents who worked or lived in the four areas and were aged 30-75 years were invited to participate in this program. Multidisciplinary HCV care teams provided outreach decentralized services of anti-HCV screening, link-to-diagnosis, and link-to-treatment with direct-acting antiviral agents (DAA). The primary end-point was sustained virological response (SVR). RESULTS Of 8291 registered residents who were invited as the target population, 7807 (94.2%) subjects received anti-HCV screening, with the average anti-HCV prevalence rate of 14.2% (1108/7807) (range among four areas: 11.8%-16.7%). The rate of link-to-diagnosis was 94.4% (1046/1108) of anti-HCV-positive subjects (range: 90.9%-100%) with an average HCV-viremic rate of 55.1% (576/1046) (range: 50.0%-64.3%). The link-to-treat rate was 94.4% (544/576) in HCV-viremic subjects (range from 92.7% to 97.2%). Overall, 523 (96.1%) patients achieved an SVR (range: 94.7%-97.6%). Eventually, the overall effectiveness was 80.7% (range: 74.6%-93.1%). The presence of hepatocellular carcinoma at baseline was the only factor associated with DAA failure. The DAA regimens were well-tolerated. CONCLUSION The outreach decentralized community-based care system with DAA therapy was highly effective and safe in the achievement of HCV micro-elimination in the resource-constrained rural and remote regions, which could help us to tackle the disparity.
Collapse
Affiliation(s)
- Ching-Chu Lo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddihist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Ying-Che Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital Yuli Branch, Taipei, Taiwan
| | - Jow-Jyh Hwang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chen-Yu Lo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan; Eberly College of Science, Department of Biology, Schreyer Honors College, Pennsylvania State University, United States
| | - Chien-Hung Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Hsu-Sheng Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Yee-Tam Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Po-Cheng Liang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung, Taiwan
| | - Meng-Jau Chiou
- Taoyuan District Public Health Center, Kaohsiung, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung, Taiwan; School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung, Taiwan; School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| |
Collapse
|
12
|
Fiore V, Manca V, Colpani A, De Vito A, Maida I, Madeddu G, Babudieri S. Facing HCV as a Major Public Healthcare Threat in Italy: Epidemiology and Micro-Elimination Pathways among Underserved Populations. Healthcare (Basel) 2023; 11:2109. [PMID: 37510549 PMCID: PMC10379370 DOI: 10.3390/healthcare11142109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Underserved populations have a wide heterogeneity on healthcare provision and use. They also represent the key populations according to WHO 2030 goals for HCV micro-elimination. Our review evaluated the available literature on HCV diagnosis, staging, and treatment among underserved populations, such as incarcerated people, patients with psychiatric disorders, and migrants. A narrative review of literature was performed using key electronic databases (Scopus, Pubmed-MEDLINE) and search engines (Google Scholar). Peer-reviewed publications, grey literature on HCV, and recent models proposed for micro-elimination in underserved populations were included. An insight into the COVID-19 pandemic and its influence on HCV micro-elimination pathways will be also provided. Regarding prison settings, a progressive reduction in HCV epidemiology among incarcerated people in the last years was found (one-third of the level it had been before). People suffering from psychiatric disorders have a high anti-HCV prevalence, but there is a lack of data on active infections. A bidirectional relationship between HCV and psychiatric disorders was found. Migrants showed a very inconsistent assessment of HCV. Furthermore, available studies recorded data from populations with high heterogeneity of anti-HCV prevalence, Therefore, the reported results need caution in their evaluation.
Collapse
Affiliation(s)
- Vito Fiore
- Unit of Infectious and Tropical Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Valentina Manca
- Unit of Infectious and Tropical Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Agnese Colpani
- Unit of Infectious and Tropical Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious and Tropical Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Ivana Maida
- Unit of Infectious and Tropical Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious and Tropical Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
13
|
Collatuzzo G, La Vecchia C, Parazzini F, Alicandro G, Turati F, Di Maso M, Malvezzi M, Pelucchi C, Negri E, Boffetta P. Cancers attributable to infectious agents in Italy. Eur J Cancer 2023; 183:69-78. [PMID: 36801622 DOI: 10.1016/j.ejca.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To provide an evidence-based, comprehensive assessment of the current burden of infection-related cancers in Italy. METHODS We calculated the proportion of cancers attributable to infectious agents (Helicobacter pylori [Hp]; hepatitis B virus [HBV] and hepatitis C virus [HCV]; human papillomavirus [HPV]; human herpesvirus-8 [HHV8]; Epstein-Barr virus [EBV]; and human immunodeficiency virus [HIV]) to estimate the burden of infection-related cancer incidence (2020) and mortality (2017). Data on the prevalence of infections were derived from cross-sectional surveys of the Italian population, and relative risks from meta-analyses and large-scale studies. Attributable fractions were calculated based on the counterfactual scenario of a lack of infection. RESULTS We estimated that 7.6% of total cancer deaths in 2017 were attributable to infections, with a higher proportion in men (8.1%) than in women (6.9%). The corresponding figures for incident cases were 6.5%, 6.9% and 6.1%. Hp was the first cause of infection-related cancer deaths (3.3% of the total), followed by HCV (1.8%), HIV (1.1%), HBV (0.9%), HPV, EBV and HHV8 (each ≤0.7%). Regarding incidence, 2.4% of the new cancer cases were due to Hp, 1.3% due to HCV, 1.2% due to HIV, 1.0% due to HPV, 0.6% due to HBV and <0.5% due to EBV and HHV8. CONCLUSIONS Our estimate of 7.6% of cancer deaths and 6.9% of incident cases that were attributable to infections in Italy is higher than those estimated in other developed countries. Hp is the major cause of infection-related cancer in Italy. Prevention, screening and treatment policies are needed to control these cancers, which are largely avoidable.
Collapse
Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy; Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Matteo Malvezzi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.
| |
Collapse
|
14
|
Women Living with HIV in Italian Prison Settings: Results from the Gender-Specific ROSE Network. Viruses 2023; 15:v15020497. [PMID: 36851711 PMCID: PMC9968113 DOI: 10.3390/v15020497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Incarcerated women are a minority in the Italian prison population. The lack of prevention and awareness of HIV infection and the lack of access to treatment make the treatment path difficult. METHODS we conducted a multi-center study including incarcerated women living with HIV (WLWH). RESULTS The study included 85 WLWH with a mean age of 41.7 ± 8.7 years, and 58.8% (50/85) of them were Italian. Principally, HIV transmission was related to sexual intercourse, 47% of all patients were PWIDs, and 62.5% of them were on opioid substitution therapy (OST). Overall, 56.4% of the included patients had a CD4+ cell count of >500 cells/mmc. Among the participants, 92.9% were on antiretroviral therapy, 87.3% had treatment before incarceration, and 83.5% were virologically suppressed. Among the 13 non-virally-suppressed patients, 53.8% were unaware of their serological status before incarceration and had started HAART but were still not virologically suppressed; 46.2% (6/13) had a lack of compliance or had suspended the treatment before incarceration and restarted it after admission. All patients with chronic hepatitis C underwent treatment with direct-acting antivirals and reached a sustained virological response. CONCLUSIONS the detention of these women could represent an occasion for the patients' healthcare provision and use, and the creation of a gender-specific network can be an effective strategy for reaching this population.
Collapse
|
15
|
Busschots D, Kremer C, Bielen R, Koc ÖM, Heyens L, Nevens F, Hens N, Robaeys G. Hepatitis C prevalence in incarcerated settings between 2013–2021: a systematic review and meta-analysis. BMC Public Health 2022; 22:2159. [PMID: 36419013 PMCID: PMC9685883 DOI: 10.1186/s12889-022-14623-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background The introduction of highly effective direct-acting antiviral therapy has changed the hepatitis C virus (HCV) treatment paradigm. However, a recent update on HCV epidemiology in incarcerated settings is necessary to accurately determine the extent of the problem, provide information to policymakers and public healthcare, and meet the World Health Organization's goals by 2030. This systematic review and meta-analysis were performed to determine the prevalence of HCV Ab and RNA in incarcerated settings. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of Science for papers published between January 2013 and August 2021. We included studies with information on the prevalence of HCV Ab or RNA in incarcerated settings. A random-effects meta-analysis was done to calculate the pooled prevalence and meta-regression to explore heterogeneity. Results Ninety-two unique sources reporting data for 36 countries were included. The estimated prevalence of HCV Ab ranged from 0.3% to 74.4%. HCV RNA prevalence (available in 46 sources) ranged from 0% to 56.3%. Genotypes (available in 19 sources) 1(a) and 3 were most frequently reported in incarcerated settings. HCV/HIV coinfection (available in 36 sources) was highest in Italy, Estonia, Pakistan, and Spain. Statistical analysis revealed that almost all observed heterogeneity reflects real differences in prevalence between studies, considering I2 was very high in the meta-analysis. Conclusions HCV in incarcerated settings is still a significant problem with a higher prevalence than in the general population. It is of utmost importance to start screening for HCV (Ab and RNA) in incarcerated settings to give clear, reliable and recent figures to plan further treatment. This is all in the context of meeting the 2030 WHO targets which are only less than a decade away. Trial registration PROSPERO: CRD42020162616 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14623-6.
Collapse
|
16
|
Fiore V, De Vito A, Colpani A, Manca V, Maida I, Madeddu G, Babudieri S. Viral Hepatitis C New Microelimination Pathways Objective: Psychiatric Communities HCV Free. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111873. [PMID: 36431008 PMCID: PMC9697639 DOI: 10.3390/life12111873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with psychiatric disorders have a high prevalence of HCV. For this reason, tailored interventions should be developed to reach this population. METHODS We performed a retrospective study on patients treated for HCV infection in psychiatric nursing homes, approached with a quick diagnosis, staging and treatment. RESULTS We included data on 586 people screened for HCV with quick tests. High HCV seroprevalence was found in this population (231; 39.4%). Among people who tested positive, there were high rates of active infection (220; 95.2%). Out of the 220 patients with active infection, 95.9% were male, 85.5% were Italian, median age was 43 (IQR = 35-52) years old. In the majority of cases (162; 73.6%), the risk factor was unknown. The most common genotype was 3a (98; 44.5%), and patients mostly had a low fibrosis, according with FIB-4 value (142; 64.5%). Of them, one (0.45%) categorically refused the treatment, and one (0.45%) had liver cirrhosis and advanced hepatocellular carcinoma. Overall, 218 patients underwent eligibility for DAAs. The most prescribed treatment was glecaprevir/pibrentasvir (GLE/PIB (172; 78.2%)). The others practiced sofosbuvir/velpatasvir (SOF/VEL). All patients reached the end of treatment. One (0.45%) was lost to follow up, and all the others reached the SVR12. CONCLUSIONS The point-of-care testing and pangenotypic DAAs' availability represent one of the most important steps for a fast diagnostic and therapeutical option. Tailored microelimination pathways for every difficult-to-reach/to-treat populations are needed. This would allow us to move more easily towards HCV elimination.
Collapse
|
17
|
Fiore V, De Matteis G, Pontali E, De Vito A, Panese S, Geremia N, Maida I, Artioli S, Starnini G, Madeddu G, Babudieri S. Quick diagnosis, staging, and treatment of HCV infection among people living in prison: Opinion expert panel. Front Public Health 2022; 10:926414. [PMID: 36268000 PMCID: PMC9577224 DOI: 10.3389/fpubh.2022.926414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/23/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Vito Fiore
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy,*Correspondence: Vito Fiore
| | - Giuseppe De Matteis
- Health Protection for Adults and Youth Unit, Penitentiary Institute, Salerno, Italy
| | | | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sandro Panese
- Unit of Infectious Diseases, Department of Clinical Medicine, Dell'Angelo Hospital, Venice, Italy
| | - Nicholas Geremia
- Unit of Infectious Diseases, Department of Clinical Medicine, Dell'Angelo Hospital, Venice, Italy
| | - Ivana Maida
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefania Artioli
- Infectious Diseases and Hepatology Unit, Sant'Andrea Hospital La Spezia, La Spezia, Italy
| | - Giulio Starnini
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| |
Collapse
|
18
|
Fiore V, Rastrelli E, Madeddu G, Ranieri R, De Vito A, Giuliani R, Di Mizio G, Bolcato M, De Matteis G, Ialungo AM, Dell'Isola S, Starnini G, Babudieri S. HCV spread among female incarcerated population and treatment pathways to viral elimination in Italian prison settings: clinical perspectives and medico legal aspects. BMC Infect Dis 2022; 22:601. [PMID: 35799126 PMCID: PMC9264562 DOI: 10.1186/s12879-022-07565-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is more frequent among incarcerated people than in general population. In the DAAs era, the short schedules and the low risk of adverse reactions, increased the number of HCV treatments. However, the most part of literature reports lack of incarcerated women inclusion in studies on field. Our aim is to assess the screening execution, HCV prevalence, and DAAs treatment among incarcerated women. A focused insight on quick vs standard diagnosis and staging approach will be also provided.
Methods Incarcerated women from 4 Italian regions’ penitentiary institutes were included. HCV screening was executed with HCV saliva test (QuickOral Test®) or phlebotomy. Stage of liver fibrosis was evaluated with FIB-4 value or fibroscan®, based on physicians’ decision. Treatment prescription followed national protocols. Results We included 156 women, 89 (57%) were Italian, mean age was 41 ± 10 years, and 28 (17.9%) were people who inject drugs (PWIDs). Overall, the HCV seroprevalence was 20.5%. Being PWID and on opioid substitution therapy (OST) were significantly associated with serological status (p-value < 0.001). Of them, the 75.5% of patients had active infection, the most frequent genotype was 3a (50%). Among them, 4 (16.6%) and 6 (25%) had psychosis or alcohol abuse history. The 62.5%, 25% and 12.5% had low, intermediate, and advanced fibrosis, respectively. Out of the 24 HCV-RNA positive patients, the 75% underwent to DAAs treatment. The sustained virological response (SVR12) was achieved in 88.8% of cases. When evaluating the influence of quick diagnosis and staging methods vs standard phlebotomy and fibroscan® on SVR12, FIB-4 use showed higher performance for retainment in treatment during prison staying (p = 0.015), while the use of quick saliva test had no influence on the outcome (p = 0.22). Conclusion HCV seroprevalence and active infections are very high among incarcerated women. More tailored interventions should be focused on HCV diagnosis and treatment in female prison population. The use of quick staging methods (FIB-4) is useful to increase SVR12 achievement without delays caused by the fibroscan® awaiting.
Collapse
Affiliation(s)
- Vito Fiore
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy.
| | - Elena Rastrelli
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Giordano Madeddu
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| | - Roberto Ranieri
- Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea De Vito
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| | - Ruggero Giuliani
- Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Magna Graecia, University of Catanzaro, Catanzaro, Italy
| | - Matteo Bolcato
- Legal Medicine, University of Padua, 35121, Padova, Italy
| | - Giuseppe De Matteis
- Health Protection for Adults and Youth Unit, Penitentiary Institute, Salerno, Italy
| | - Anna Maria Ialungo
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Serena Dell'Isola
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Giulio Starnini
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Sergio Babudieri
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| |
Collapse
|
19
|
Sharma S, Thomas E, Caputi M, Asghar W. RT-LAMP-Based Molecular Diagnostic Set-Up for Rapid Hepatitis C Virus Testing. BIOSENSORS 2022; 12:298. [PMID: 35624599 PMCID: PMC9138684 DOI: 10.3390/bios12050298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Hepatitis C virus (HCV) infections occur in approximately 3% of the world population. The development of an enhanced and extensive-scale screening is required to accomplish the World Health Organization's (WHO) goal of eliminating HCV as a public health problem by 2030. However, standard testing methods are time-consuming, expensive, and challenging to deploy in remote and underdeveloped areas. Therefore, a cost-effective, rapid, and accurate point-of-care (POC) diagnostic test is needed to properly manage the disease and reduce the economic burden caused by high case numbers. Herein, we present a fully automated reverse-transcription loop-mediated isothermal amplification (RT-LAMP)-based molecular diagnostic set-up for rapid HCV detection. The set-up consists of an automated disposable microfluidic chip, a small surface heater, and a reusable magnetic actuation platform. The microfluidic chip contains multiple chambers in which the plasma sample is processed. The system utilizes SYBR green dye to detect the amplification product with the naked eye. The efficiency of the microfluidic chip was tested with human plasma samples spiked with HCV virions, and the limit of detection observed was 500 virions/mL within 45 min. The entire virus detection process was executed inside a uniquely designed, inexpensive, disposable, and self-driven microfluidic chip with high sensitivity and specificity.
Collapse
Affiliation(s)
- Sandhya Sharma
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA;
- Asghar-Lab: Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA
| | - Emmanuel Thomas
- Department of Microbiology and Immunology and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL 33136, USA;
| | - Massimo Caputi
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Waseem Asghar
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA;
- Asghar-Lab: Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA
- Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL 33431, USA
| |
Collapse
|
20
|
Chandra Deb L, Hove H, Miller TK, Pinks K, Njau G, Hagan JJ, Jansen RJ. Epidemiology of Hepatitis C virus infection among incarcerated populations in North Dakota. PLoS One 2022; 17:e0266047. [PMID: 35349606 PMCID: PMC8963564 DOI: 10.1371/journal.pone.0266047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/12/2022] [Indexed: 12/09/2022] Open
Abstract
This retrospective cohort study was conducted to determine the prevalence of HCV infections among individuals incarcerated in a state prison system and identify potential contributing factors to HCV infection. North Dakota Department of Corrections and Rehabilitation (NDDOCR) data from 2009 to 2018 was used and period prevalence was calculated for this 10-year time period. The period prevalence of HCV infection was (15.13% (95% CI 14.39–15.90) with a marginally significant (p-value: 0.0542) increasing linear trend in annual prevalence over this period. Multivariate logistic regression analysis was used to identify risk factors associated with HCV infection. The main significant independent risk factors for HCV infection in this incarcerated population were age >40 years [OR: 1.78 (1.37–2.32)]; sex [OR: 1.21 (1.03–1.43)]; race/ethnicity [OR: 1.97 (1.69–2.29)]; history of intravenous drug use (IVDU) [OR: 7.36 (6.41–8.44)]; history of needle or syringe sharing [OR: 7.57 (6.62–8.67)]; and alcohol use [OR: 0.87 (0.77–0.99)]. Study limitations include uncollected information on sexual history, frequency or duration of injection drug use and blood transfusion history of the incarcerated population. Considering the high prevalence of HCV infection and its associated risk factors, it is important to implement prevention programs such as syringe/needle exchanges and counsel with imprisoned IVD users.
Collapse
Affiliation(s)
- Liton Chandra Deb
- Department of Public Health, North Dakota State University, Fargo, ND, United States of America
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States of America
| | - Hannah Hove
- Department of Public Health, North Dakota State University, Fargo, ND, United States of America
- University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States of America
| | - Tracy K. Miller
- North Dakota Department of Health, Bismarck, ND, United States of America
| | - Kodi Pinks
- North Dakota Department of Health, Bismarck, ND, United States of America
| | - Grace Njau
- North Dakota Department of Health, Bismarck, ND, United States of America
| | - John J. Hagan
- North Dakota Department of Corrections and Rehabilitation, Bismarck, ND, United States of America
| | - Rick J. Jansen
- Department of Public Health, North Dakota State University, Fargo, ND, United States of America
- Genomics, Phenomics, and Bioinformatics Program, North Dakota State University, Fargo, ND, United States of America
- Center for Immunization Research and Education (CIRE), North Dakota State University, Fargo, ND, United States of America
- Center for Diagnostic and Therapeutic Strategies in Pancreatic Cancer, North Dakota State University, Fargo, ND, United States of America
- * E-mail:
| |
Collapse
|
21
|
Kondili LA, Andreoni M, Alberti A, Lobello S, Babudieri S, De Michina A, Merolla R, Marrocco W, Craxì A. A mathematical model by route of transmission and fibrosis progression to estimate undiagnosed individuals with HCV in different Italian regions. BMC Infect Dis 2022; 22:58. [PMID: 35038987 PMCID: PMC8761836 DOI: 10.1186/s12879-022-07042-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although an increase in hepatitis C virus (HCV) prevalence from Northern to Southern Italy has been reported, the burden of asymptomatic individuals in different Italian regions is currently unknown. METHODS A probabilistic approach, including a Markov chain for liver disease progression, was applied to estimate current HCV viraemic burden. The model defined prevalence by geographic area using an estimated annual historical HCV incidence by age, treatment rate, and migration rate from the Italian National database. Viraemic infection by age group was estimated for each region by main HCV transmission routes of individuals for stage F0-F3 (i.e. patients without liver cirrhosis and thus potentially asymptomatic) and F4 (patients with liver cirrhosis, thus potentially symptomatic). RESULTS By January 2020, it was estimated that there were 409,184 Italian individuals with HCV (prevalence of 0.68%; 95% CI: 0.54-0.82%), of which 300,171 (0.50%; 95% CI: 0.4-0.6%) were stage F0-F3. Considering all individuals with HCV in stage F0-F3, the geographical distributions (expressed as the proportion of HCV infected individuals by macroarea within the overall estimated number of F0-F3 individuals and prevalence values, expressed as the percentage of individuals with HCV versus the overall number of individuals for each macroarea) were as follows: North 42.1% (0.45%; 95% CI: 0.36-0.55%), Central 24.1% (0.61%; 95% CI: 0.48-0.74%), South 23.2% (0.50%; 95% CI: 0.4-0.61%), and the Isles 10.6% (0.49%; 95% CI: 0.39-0.59%). The population of people who inject drugs accounted for 50.4% of all individuals infected (F0-F3). Undiagnosed individuals (F0-F3) were ~ 15 years younger (⁓ 50 years) compared with patients with stage F4 (⁓ 65 years), with similar age distributions across macroareas. In contrast to what has been reported on HCV epidemiology in Italy, an increasing trend in the proportion of potentially undiagnosed individuals with HCV (absolute number within the F0-F3) from South (23.2%) to North (42.1%) emerged, independent of similar regional prevalence values. CONCLUSION This targeted approach, which addresses the specific profile of undiagnosed individuals, is helpful in planning effective elimination strategies by region in Italy and could be a useful methodology for other countries in implementing their elimination plans.
Collapse
Affiliation(s)
- Loreta A Kondili
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
| | | | - Alfredo Alberti
- Department of Molecular Medicine DMM, University of Padova, Padua, Italy
| | | | | | | | | | | | - Antonio Craxì
- Gastroenterology and Liver Unit, DiBiMIS, University of Palermo, Palermo, Italy
| |
Collapse
|
22
|
Supanan R, Han WM, Harnpariphan W, Ueaphongsukkit T, Ubolyam S, Sophonphan J, Tangkijvanich P, Thanprasertsuk S, Avihingsanon A. Brief Report: HCV Universal Test-and-Treat With Direct Acting Antivirals for Prisoners With or Without HIV: A Prison Health Care Workers-Led Model for HCV Microelimination in Thailand. J Acquir Immune Defic Syndr 2021; 88:465-469. [PMID: 34757974 DOI: 10.1097/qai.0000000000002801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/23/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study investigated the sustained virologic responses (SVRs) among prisoners with hepatitis C virus (HCV) using universal test-and-treat approach by prison health care workers in a central male prison in Thailand. METHODS A universal HCV screening was conducted in a maximum-security central prison (Klong Prem Central Prison) in Thailand. HCV RNA-confirmed prisoners were treated with generic sofosbuvir/velpatasvir by prison health care workers, regardless of their HCV genotypes and duration of prison sentences. We evaluated the SVR rates at 12 weeks after completing direct acting antivirals (DAA) treatment. RESULTS A total of 68 prisoners with detectable HCV RNA received DAA treatment. The median age and duration of prison sentences were 44 years (interquartile range, 41-53) and 25 (interquartile range, 19-33) years, respectively. Twenty-five percentage of the participants was coinfected with HIV, and 6% of the participants was coinfected with hepatitis B virus. Among all prisoners who received DAA treatment, 20 (29%) had genotype (GT)-1a, 3 (4%) had GT-1b, 22 (32%) had GT-3a, 3 (4%) had GT-3b, and 7 (10%) had GT-6. Overall, improvements in liver biomarkers were seen after HCV treatment, and SVR was achieved in 97% of the participants with per-protocol analysis and in 90% of the participants with intention-to-treat analysis. CONCLUSIONS HCV treatment using DAA among prisoners through universal test-and-treat approach led by prison health care workers is highly effective and safe, and such model can potentially help to facilitate the goals of HCV microelimination among prisoners in Thailand.
Collapse
Affiliation(s)
| | - Win Min Han
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Sasiwimol Ubolyam
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Pisit Tangkijvanich
- Department of Biochemistry, Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; and
| | - Sombat Thanprasertsuk
- Department of Disease Control, Preventive Medicine, Ministry of Public Health, Nonthaburi, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
23
|
Lazarus JV, Herranz A, Picchio CA, Villota-Rivas M, Rodríguez A, Alonso JM, Moratinos A, Perrotta A, Tegeo E, Bibiloni F, Buti M, Vilella À. Eliminating hepatitis C on the Balearic Islands, Spain: a protocol for an intervention study to test and link people who use drugs to treatment and care. BMJ Open 2021; 11:e053394. [PMID: 34675021 PMCID: PMC8532552 DOI: 10.1136/bmjopen-2021-053394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The hepatitis C virus (HCV) is a highly infectious and deadly disease, affecting some 58 million people worldwide. Of the 1.13 million people living in the Balearic Islands, Spain, about 1350 individuals have untreated HCV. Of these, about 1120 (83%) are estimated to be people who use drugs (PWUD), who are one of the key at-risk groups for HCV infection globally. Carrying out micro-elimination approaches focused on this population is crucial to achieve the WHO goal of eliminating HCV by 2030. Thus, the primary objective of this study is to validate a model of care that simplifies the screening and linkage to HCV care pathways for PWUD on the Balearic Islands. METHODS AND ANALYSIS This intervention study will be implemented across 17 sites, in 4 different settings: addiction service centres (n=12), non-governmental organisation centres (n=3), a mobile methadone unit and a prison, with an estimated 3725 participants. Together with the healthcare staff at each centre, the intervention protocols will be adapted, focusing on four phases: recruitment and testing; linkage to care; treatment for those who test positive; and monitoring of sustained virological response 12 weeks after treatment and reinfection. The primary outcomes will be the number of tested and treated individuals and the secondary outcomes will include individuals lost at each step in the cascade of care. Descriptive analysis and multivariable logistic regression of the data will be undertaken. ETHICS AND DISSEMINATION The Hospital Clínic Barcelona, Spain, Ethics Committee approved this study on 18 February 2021 (HCB/2020/2018). Findings will be disseminated through peer-reviewed publications, conference presentations and social media. The results of this study could provide a model for targeting PWUD for HCV testing and treatment in the rest of Spain and in other settings, helping to achieve the WHO HCV elimination goal.
Collapse
Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Andrea Herranz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Antonia Rodríguez
- Servicio médico, Centro Penitenciario de Mallorca, Palma de Mallorca, Spain
| | | | - Albert Moratinos
- Unitat de Conductes Addictives, Institut d'Afers Socials Mallorquí (IMAS), Palma de Mallorca, Spain
| | | | - Elisabet Tegeo
- Sector mèdic, Projecte Home Balears, Illes Balears, Spain
| | - Francisca Bibiloni
- Pla d'addiccions i drogodependències de les Illes Balears (PADIB), Conselleria de Salut i Consum, Govern de les Illes Balears, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER-EHD, Instituto de Salud Carlos III, Madrid, Spain
| | - Àngels Vilella
- Department of Gastroenterology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| |
Collapse
|
24
|
Chronic Viral Hepatitis in the Italian Prison Setting: Prevalence, Outcomes, Literature Needs and Perspectives. Healthcare (Basel) 2021; 9:healthcare9091186. [PMID: 34574960 PMCID: PMC8467805 DOI: 10.3390/healthcare9091186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 01/13/2023] Open
Abstract
Compared with the general population, incarcerated people have a higher prevalence of several communicable diseases, including viral hepatitis. Nevertheless, there is still a lack of literature in field. Our review aims to shed the actual knowledge on viral hepatitis among incarcerated people in Italy. We performed a comprehensive literature search, through key electronic databases (Scopus, Pubmed–MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles and reviews), grey literature on viral hepatitis prevalence, and models proposed for active case finding and control strategies in prison settings. We found that viral hepatitis epidemiology drastically changed in the last five years, particularly on hepatitis C virus (HCV), reporting an HCV antibody (HCV-Ab) prevalence decrease from up to 38% to ˂20% in penitentiary institutes, as well as an even more important reduction in active infections. Probably, the availability of direct-acting antivirals is contributing to this scenario. However, there is a lack of data available regarding incarcerated women. For this reason, more tailored interventions are needed for this sub-population. Judiciary and regulatory bodies should be prompted to discuss and define specific regulations to optimize case active finding strategies, guarantee wide access to effective preventive and treatment options for viral hepatitis and enhance treatment management.
Collapse
|
25
|
Fiore V, De Vito A, Madeddu G, Babudieri S. SARS-CoV-2 Vaccination Among Incarcerated People: A Barrier to Overcome. Front Public Health 2021; 9:704520. [PMID: 34458225 PMCID: PMC8387629 DOI: 10.3389/fpubh.2021.704520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Vito Fiore
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Italian Society of Penitentiary Healthcare, Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Italian Society of Penitentiary Healthcare, Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,SIMSPe School, Viterbo, Italy
| |
Collapse
|
26
|
Dennis BB, Naji L, Jajarmi Y, Ahmed A, Kim D. New hope for hepatitis C virus: Summary of global epidemiologic changes and novel innovations over 20 years. World J Gastroenterol 2021; 27:4818-4830. [PMID: 34447228 PMCID: PMC8371499 DOI: 10.3748/wjg.v27.i29.4818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/20/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a global health concern associated with significant morbidity and mortality. Before the approval of second-generation direct-acting antiviral agents (DAAs), interferon therapy and liver transplantation constituted the mainstay of treatment. The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95% cure rates. The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs. Despite the unparallel efficacy observed among these novel therapies, pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally. To reduce the burden of disease worldwide, essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies. Through transparent negotiations with the pharmaceutical industry, the consideration for compassionate release of medications to promote equitable division of care is paramount. Here we provide a literature review of HCV, changes in epidemiologic trends, access issues for current therapies, and global inequities in disease burden.
Collapse
Affiliation(s)
- Brittany B Dennis
- Department of Medicine, McMaster University, Hamilton L8S 4L8, ON, Canada
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94304, United States
| | - Leen Naji
- Department of Family Medicine, McMaster University, Hamilton L8P 1H6, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton L8S 4K1, ON, Canada
| | - Yasmin Jajarmi
- Department of Medicine, McMaster University, Hamilton L8S 4L8, ON, Canada
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94304, United States
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94304, United States
| |
Collapse
|
27
|
Busschots D, Kremer C, Bielen R, Koc ÖM, Heyens L, Brixko C, Laukens P, Orlent H, Bilaey P, De Smet F, Hellemans G, Muyldermans G, Van Baelen L, Hens N, Van Vlierberghe H, Robaeys G. A multicentre interventional study to assess blood-borne viral infections in Belgian prisons. BMC Infect Dis 2021; 21:708. [PMID: 34315415 PMCID: PMC8314587 DOI: 10.1186/s12879-021-06405-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/18/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Prevalence data on viral hepatitis B (HBV), hepatitis C (HCV), and HIV infection in prison are often scarce or outdated. There is currently no systematic screening for these blood-borne viral infections (BBV) in Belgian prisons. There is an urgency to assess the prevalence of these BBV to inform policymakers and public healthcare. METHODS This was a multicentre, interventional study to assess the prevalence of BBV using opt-in screening in prisons across Belgium, April 2019 - March 2020. Prisoners were tested using a finger prick and BBV risk factors were assessed using a questionnaire. A generalized linear mixed model was used to investigate the association between the various risk factors and HCV. RESULTS In total, 886 prisoners from 11 Belgian prisons were screened. Study uptake ranged from 16.9 to 35.4% in long-term facilities. The prevalence of HCV antibodies (Ab), hepatitis B surface antigen (Ag) and HIV Ab/Ag was 5.0% (44/886), 0.8% (7/886), and 0.2% (2/886). The adjusted odds for HCV Ab were highest in prisoners who ever injected (p < 0.001; AOR 24.6 CI 95% (5.5-215.2). The prevalence of detectable HCV RNA in the total cohort was 2.1% (19/886). Thirteen (68.4%) prisoners were redirected for follow-up of their HCV infection. CONCLUSIONS Opt-in testing for viral hepatitis B, C and HIV was relatively well-accepted in prisons. Compared with the general population, prisoners have a higher prevalence of infection with BBV, especially for HCV. Systematic screening for these BBV should be recommended in all prisons, preferably using opt-out to optimize screening uptake. TRIAL REGISTRATION Retrospectively registered at clinical trials NCT04366492 April 29, 2020.
Collapse
Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - Cécile Kremer
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-Biostat), Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Özgür M Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,School of NUTRIM, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Leen Heyens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,School of NUTRIM, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Christian Brixko
- Department of Gastroenterology and Hepatology, CHR Citadelle, Liège, Belgium.,Dienst Coördinatie Medische Zorg, Federale Overheidsdienst Justitie, Brussel, Belgium
| | - Pierre Laukens
- Dienst Coördinatie Medische Zorg, Federale Overheidsdienst Justitie, Brussel, Belgium
| | - Hans Orlent
- Dienst Coördinatie Medische Zorg, Federale Overheidsdienst Justitie, Brussel, Belgium.,Department of Gastroenterology and Hepatology, AZ St-Jan, Bruges, Belgium.,Department of Gastroenterology and Hepatology, UZ Gent, Ghent, Belgium
| | - Pascal Bilaey
- Dienst Coördinatie Medische Zorg, Federale Overheidsdienst Justitie, Brussel, Belgium
| | - Francis De Smet
- Dienst Coördinatie Medische Zorg, Federale Overheidsdienst Justitie, Brussel, Belgium
| | - Geert Hellemans
- Dienst Coördinatie Medische Zorg, Federale Overheidsdienst Justitie, Brussel, Belgium
| | | | - Luk Van Baelen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-Biostat), Data Science Institute, Hasselt University, Diepenbeek, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | | | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| |
Collapse
|
28
|
Seroprevalence and associated factors of HIV and Hepatitis C in Brazilian high-security prisons: A state-wide epidemiological study. PLoS One 2021; 16:e0255173. [PMID: 34310633 PMCID: PMC8312944 DOI: 10.1371/journal.pone.0255173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/11/2021] [Indexed: 12/19/2022] Open
Abstract
The prevalence of hepatitis C virus (HCV) and the acquired immunodeficiency virus (HIV) is much higher in prisons than in community settings. Some explanatory factors for this burden include putative aspects of the prison environment, such as unprotected sexual relations and sexual violence, use of injectable drugs and syringe sharing. Nonetheless, efforts in better understanding the dynamics of both HCV and HIV are scarce in developing countries such as Brazil, which poses a risk not only to the inmates but to the community as well. In this investigation, we sought to determine the seroprevalence and sociodemographic and behavioral risk factors associated with HIV and anti-HCV antibodies among men detained at high-security institutions. This is an epidemiological, proportionally stratified observational study including 1,132 inmates aged 18 to 79 years-old (Mage = 32.58±10.18) from eleven high-security prisons located in the State of Paraná, Brazil. We found that HIV and anti-HCV prevalence were 1.6% (95% CI: 1.0–2.5) and 2.7% (95% CI: 1.0–2.5), respectively. Risk factors associated with HIV included not receiving intimate visits (OR = 8.80, 95% CI: 1.15–66.88), already having another sexually transmitted infection (OR = 3.89, 95% CI: 1.47–10.29), and reporting attendance in HIV preventive campaigns (OR = 4.24, 95% CI: 1.58–11.36). Moreover, anti-HCV seroprevalence was associated with higher age (OR = 4.03, 95% CI: 1.61–10.07), criminal recidivism (OR = 2.58, 95% CI 1.02–6.52), and the use of injectable drugs (OR = 7.32, 95% CI 3.36–15.92). Although prisons might increase the risk for acquiring and transmitting HIV and HCV, the adoption of permanent epidemiological surveillance programs could help reducing the circulation of viruses, involving strategies focusing on screening, treating, and preventing infections to assure proper prisoner health. Moreover, these policies need to take place inside and outside the prison environment to offer continued assistance to former prisoners once they leave the institution.
Collapse
|
29
|
Wong YJ, Thurairajah PH, Kumar R, Fock KM, Law NM, Chong SY, Manejero FG, Ang TL, Teo EK, Tan J. The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients. Clin Mol Hepatol 2021; 27:474-485. [PMID: 33601868 PMCID: PMC8273645 DOI: 10.3350/cmh.2021.0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore. METHODS In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013-2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types. RESULTS A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001). CONCLUSION In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination.
Collapse
Affiliation(s)
- Yu Jun Wong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Rahul Kumar
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Ngai Moh Law
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sin-Yoong Chong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | | | - Tiing-Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Eng Kiong Teo
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Jessica Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| |
Collapse
|
30
|
Schmidbauer C, Schwarz M, Schütz A, Schubert R, Schwanke C, Gutic E, Pirker R, Lang T, Reiberger T, Haltmayer H, Gschwantler M. Directly observed therapy at opioid substitution facilities using sofosbuvir/velpatasvir results in excellent SVR12 rates in PWIDs at high risk for non-adherence to DAA therapy. PLoS One 2021; 16:e0252274. [PMID: 34086708 PMCID: PMC8177501 DOI: 10.1371/journal.pone.0252274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background & aims We evaluated the effectiveness of sofosbuvir/velpatasvir (SOF/VEL) in difficult-to-treat PWIDs with presumed high risk for non-adherence to antiviral therapy using an innovative concept involving their opioid agonist therapy (OAT) facility. Methods N = 221 patients (m/f: 168/53; median age: 44.7 years (IQR 16.9); HCV-genotype 3: 45.2%; cirrhosis: 33.9%) treated with SOF/VEL were included. PWIDs at high risk for non-adherence to DAA therapy (n = 122) received HCV treatment alongside OAT under the supervision of medical staff ("directly observed therapy", DOT). These patients were compared to patients with presumed excellent drug compliance, who were treated in a "standard setting" (SS) of SOF/VEL prescription at a tertiary care center (n = 99). Results DOT-patients (n = 122/221; 55.2%) were younger than SS-patients (median age: 41.3 vs. 53.0 years), all had psychiatric comorbidities and most had a poor socioeconomic status. 83/122 (68.0%) reported ongoing intravenous drug use. Within the DOT-group, SVR12 was achieved in 99.1% (95% CI: 95.0–100; n = 109/110) with one patient experiencing treatment failure, while n = 12/122 (9.8%) patients were excluded due to loss of follow-up (FU). 5 patients showed HCV reinfection after achieving SVR12. SS-patients achieved SVR in 96.6% (95% CI: 90.3–99.3%; n = 84/87) after exclusion of 10/99 (10.1%) patients who were lost to FU and 2 patients who died prior to SVR12 due to reasons not related to DAA therapy. Conclusions SOF/VEL given as DOT along with OAT in PWIDs at high risk of non-adherence to antiviral therapy including those with ongoing intravenous drug use resulted in excellent SVR rates similar to patients with presumed “excellent compliance” under standard drug intake.
Collapse
Affiliation(s)
- Caroline Schmidbauer
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Michael Schwarz
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Angelika Schütz
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Raphael Schubert
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Cornelia Schwanke
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Enisa Gutic
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Roxana Pirker
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Tobias Lang
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Hans Haltmayer
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
- * E-mail:
| |
Collapse
|
31
|
Cerrato F, Esposito M, Drusiani A, Moi I, Franciosi E, Assueri N, Campalastri R, Fioritti A. Locking out the virus: management of a SARS-CoV-2 outbreak in an Italian prison. Int J Prison Health 2021; 17:258-266. [PMID: 34323430 DOI: 10.1108/ijph-12-2020-0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE In this paper, the authors present insights and findings drawn from the authors' experiences of containing a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large prison in northern Italy.Within penitentiaries, close-quarter living is ripe terrain for outbreaks of disease among detainees and staff. If left unchecked, these outbreaks can easily spill over the prison walls to threaten the general public. Moreover, these risks are heightened by preexisting environmental conditions, especially overcrowding. It is thus paramount to establish effective protocols for prevention, early detection and outbreak management. The purpose of this article is to document a strategy that been at least partially successful in reducing the damage that could potentially be caused by a sustained SARS-CoV-2 outbreak within a correctional facility. DESIGN/METHODOLOGY/APPROACH The authors conducted a retrospective analysis on patients' and health-care workers' medical records to obtain demographic and clinical information. Descriptive data analysis was then carried out. FINDINGS In total, the authors tested 453 people with oropharyngeal swabs from March 15, 2020, to June 30, 2020. Of these people, 58 were positive and 395 were negative, with a prevalence of 12.8%.Of the 453 patients, 60 were health workers: 24 tested positive for SARS-CoV2 ribonucleic acid (RNA); 18 developed symptoms; and three needed hospitalization.Among patients in detention, 34 resulted positive for SARS-CoV-2 RNA. Two were hospitalized and later died. Both had severe preexisting conditions; they were aged 76 and 59 years old, respectively. ORIGINALITY/VALUE In this study, the authors describe the design and effective implementation of prevention and containment measures against SARS-CoV-2 within the walls of a correctional facility. The authors describe how they rapidly created clean confinement sections to isolate cases in an environment designed for security at the expense of virus containment and how educational efforts have played a vital role in their strategy.
Collapse
Affiliation(s)
- Ferdinando Cerrato
- Department of Mental Health and Substane Abuse, AUSL Bologna, Bologna, Italy
| | - Michele Esposito
- DATER - Department of Nursing and Health Professions, AUSL Bologna, Bologna, Italy
| | - Agnese Drusiani
- DATER - Department of Nursing and Health Professions, AUSL Bologna, Bologna, Italy
| | - Iuri Moi
- DATER - Department of Nursing and Health Professions, AUSL Bologna, Bologna, Italy
| | - Eugenia Franciosi
- DATER - Department of Nursing and Health Professions, AUSL Bologna, Bologna, Italy
| | - Nadialina Assueri
- DATER - Department of Nursing and Health Professions, AUSL Bologna, Bologna, Italy
| | | | - Angelo Fioritti
- Department of Mental Health and Substane Abuse, AUSL Bologna, Bologna, Italy
| |
Collapse
|