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Challenges Facing Viral Hepatitis C Elimination in Lebanon. Pathogens 2023; 12:pathogens12030432. [PMID: 36986354 PMCID: PMC10057017 DOI: 10.3390/pathogens12030432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
Hepatitis C is a hepatotropic virus that causes progressive liver inflammation, eventually leading to cirrhosis and hepatocellular carcinoma if left untreated. All infected patients can achieve a cure if treated early. Unfortunately, many patients remain asymptomatic and tend to present late with hepatic complications. Given the economic and health burdens of chronic hepatitis C infection, the World Health Organization (WHO) has proposed a strategy to eliminate hepatitis C by 2030. This article describes the epidemiology of hepatitis C in Lebanon and highlights the challenges hindering its elimination. An extensive search was conducted using PubMed, Medline, Cochrane, and the Lebanese Ministry of Public Health–Epidemiologic Surveillance Unit website. Obtained data were analyzed and discussed in light of the current WHO recommendations. It was found that Lebanon has a low prevalence of hepatitis C. Incidence is higher among males and Mount Lebanon residents. A wide variety of hepatitis C genotypes exists among various risk groups, with genotype 1 being the most predominant. In Lebanon, many barriers prevent successful hepatitis C elimination, including the absence of a comprehensive screening policy, stigma, neglect among high-risk groups, economic collapse, and a lack of proper care and surveillance among the refugees. Appropriate screening schemes and early linkage to care among the general and high-risk populations are essential for successful hepatitis C elimination in Lebanon.
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Wiessing L, Kalamara E, Stone J, Altan P, Van Baelen L, Fotiou A, Garcia D, Goulao J, Guarita B, Hope V, Jauffret-Roustide M, Jurgelaitienė L, Kåberg M, Kamarulzaman A, Lemsalu L, Kivite-Urtane A, Kolarić B, Montanari L, Rosińska M, Sava L, Horváth I, Seyler T, Sypsa V, Tarján A, Yiasemi I, Zimmermann R, Ferri M, Dolan K, Uusküla A, Vickerman P. Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 – is the precautionary principle applicable? Euro Surveill 2021; 26. [PMID: 34886941 PMCID: PMC8662800 DOI: 10.2807/1560-7917.es.2021.26.49.2002093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes. Aim We aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe. Methods Aggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006–2020; n = 52,368 HIV+/−; n = 47,268 HCV+/−). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR. Results Univariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52–2.42). Pooled PR was 1.66 (95% CI 1.38–1.98), giving a PAR of 25.8% (95% CI 16.7–34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17–2.91). Pooled PR was 1.42 (95% CI: 1.28–1.58) and PAR 16.7% (95% CI: 11.8–21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe. Conclusion In univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release (‘throughcare’).
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Eleni Kalamara
- EASO MTC Block A, Winemakers Wharf, Grand Harbour Valletta, Malta
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peyman Altan
- Ministry of Health, Public Health General Directorate, Ankara, Turkey
| | - Luk Van Baelen
- Sciensano, Epidemiology and public health, Lifestyle and chronic diseases, Brussels, Belgium
| | - Anastasios Fotiou
- University Mental Health, Neurosciences, & Precision Medicine Research Institute, Athens, Greece
| | - D’Jamila Garcia
- NOVA FCSH – Universidade Nova de Lisboa, Lisbon, Portugal
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Joao Goulao
- General Director on Addictive Behaviours and Dependencies, Ministry of Health, Lisbon, Portugal
| | - Bruno Guarita
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Marie Jauffret-Roustide
- Santé Publique France, Saint-Maurice, France
- British Columbia Centre on Substance Use (BCCSU), Vancouver, Canada
- Centre d’Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR8044/EHESS), Paris, France
- Baldy Center for Law and Social Policy, Buffalo University of Social Sciences, New York, United States
| | - Lina Jurgelaitienė
- Social Innovations and Science Centre, Vilnius, Lithuania
- Drug, Tobacco and Alcohol Control Department, Vilnius, Lithuania
| | - Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Adeeba Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Liis Lemsalu
- Centre for Prevention of Drug Addiction and Infectious Diseases, National Institute for Health Development, Tallinn, Estonia
| | | | - Branko Kolarić
- Medical Faculty, University of Rijeka, Rijeka, Croatia
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Linda Montanari
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Magdalena Rosińska
- National Institute of Public Health NIH – National Research Institute, Warsaw, Poland
| | - Lavinius Sava
- National Antidrug Agency – Ministry of Internal Affairs, Bucharest, Romania
| | - Ilonka Horváth
- Gesundheit Österreich GmbH – Austrian National Public Health Institution, International Affairs and Consulting, Vienna, Austria
| | - Thomas Seyler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Tarján
- Hungarian Reitox National Focal Point, Budapest, Hungary
| | - Ioanna Yiasemi
- Monitoring Department, Cyprus National Addictions Authority, Nicosia, Cyprus
| | - Ruth Zimmermann
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, Sydney, Australia
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Sarrazin C, Boesecke C, Golsabahi‐Broclawski S, Moog G, Negro F, Silaidos C, Patel P, Lohmann K, Spinner CD, Walcher S, Wedemeyer H, Wörns M. Hepatitis C virus: Current steps toward elimination in Germany and barriers to reaching the 2030 goal. Health Sci Rep 2021; 4:e290. [PMID: 34136654 PMCID: PMC8177898 DOI: 10.1002/hsr2.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/24/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Hepatitis C virus (HCV) affects over 70 million people globally, with an estimated 399 000 HCV-related deaths in 2016. The World Health Organization (WHO) has set a goal to eliminate HCV by 2030. Despite the availability of direct-acting antivirals-highly effective and well-tolerated therapies for HCV-many patients infected with HCV in Germany have not initiated treatment, including a majority of those who are aware of their positive diagnosis. Barriers to screening, diagnosis, and treatment are major factors taking many countries off track for HCV elimination by 2030. Identifying country-specific barriers and challenges, particularly in at-risk populations such as people who inject drugs or men who have sex with men, has the potential to create tailored programs and strategies to increase access to screening or treatment and engage at-risk populations. This review aims to report the current steps toward HCV elimination in Germany, the country-specific barriers and challenges that will potentially prevent reaching the 2030 HCV elimination goal and describe good practice examples to overcome these barriers.
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Affiliation(s)
- Christoph Sarrazin
- Department of Internal Medicine and Liver CenterSt. Josefs‐Hospital Wiesbaden and Viral Hepatitis Research Group, Goethe‐University Hospital FrankfurtFrankfurtGermany
| | - Christoph Boesecke
- Department of Medicine IUniversity Hospital BonnBonnGermany
- German Centre for Infection Research (DZIF)Partner‐site Bonn‐CologneBonnGermany
| | | | - Gero Moog
- Gastroenterologische Praxis im MarienkrankenhausKasselGermany
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical PathologyGeneva University HospitalsGenevaSwitzerland
| | | | | | | | - Christoph D. Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der IsarTechnical University of MunichMunichGermany
- German Centre for Infection Research (DZIF), Partner Site MunichMunichGermany
| | | | - Heiner Wedemeyer
- Department of GastroenterologyHepatology and Endocrinology, Hannover Medical SchoolHannoverGermany
- Leberstiftungs‐GmbH DeutschlandHannoverGermany
| | - Marcus‐Alexander Wörns
- First Department of MedicineUniversity Medical Centre of the Johannes Gutenberg‐UniversityMainzGermany
- Cirrhosis Centre Mainz (CCM)University Medical Centre of the Johannes Gutenberg‐UniversityMainzGermany
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Giuliani R, Casigliani V, Fornili M, Sebastiani T, Freo E, Arzilli G, Scardina G, Baglietto L, Tavoschi L, Ranieri R. HCV micro-elimination in two prisons in Milan, Italy: A model of care. J Viral Hepat 2020; 27:1444-1454. [PMID: 32815623 DOI: 10.1111/jvh.13376] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/09/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
People in prison represent a high-risk population for HCV infection control. With the advent of new direct antiviral agents (DAAs) HCV micro-elimination in prison setting became a feasible strategy. We assessed the impact of an intervention for HCV testing and treatment in 2017 and 2018 in a jail (San Vittore,SV) and a prison for sentenced individuals (Opera,OP). A dedicated protocol was applied and implemented over the two years. We collected data on demographics, HCV testing and treatment on all inmates present on 31 October 2017 and 2018. In the two facilities, there were 2,366 and 2,369 inmates in 2017 and 2018 respectively; the majority were men (95.6%; 96.4%) and Italians (57.0%; 61.9%) with a median age of 41 years. Prevalence of lifetime reported drug use remained high (46.5%; 44.2%). HCV screening coverage was 89% in both years, while HCV RNA test coverage increased (90.6%; 99.0%). HCV seroprevalence remained stable (10.1%; 9.2%). In 2017 among inmates with HCV chronic infection 90 (42.4%) individuals had started DAAs treatment and 106 (54.6%) in 2018; of whom 38 (17.9%) and 74 (38.1%) achieved the SVR. The viremic pool decreased significantly over time (SV,24.4%; 15.4%;OP, 16.1%; <1%). Among inmates with HCV-positive serology in 2018, 121 (81.0%) were never linked to care before incarceration. Our study showed how a targeted and well-implemented HCV test-and-treat intervention in prison was feasible and effective in achieving micro-elimination. Viral hepatitis elimination agenda may help drawing interest onto this neglected population and bringing prison health higher up in the global public health agenda.
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Affiliation(s)
- Ruggero Giuliani
- Infectious Diseases Service, Penitentiary Health System, San Paolo University Hospital, Milano, Italy
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Teresa Sebastiani
- Infectious Diseases Service, Penitentiary Health System, San Paolo University Hospital, Milano, Italy
| | - Elisabetta Freo
- Infectious Diseases Service, Penitentiary Health System, San Paolo University Hospital, Milano, Italy
| | - Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuditta Scardina
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Ranieri
- Infectious Diseases Service, Penitentiary Health System, San Paolo University Hospital, Milano, Italy.,Welfare General Directorate, Lombardy Regional Health Authority, Milan, Italy
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[Somatic diseases of homeless people in Germany. A narrative literature review for the years 2009-2019]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1189-1202. [PMID: 32940746 DOI: 10.1007/s00103-020-03213-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND According to estimates, between 337,000 and 650,000 people in Germany live without a permanent residence. They are highly deprived in terms of health. Studies on the health situation are rare and methodologically heterogeneous. Previous reviews have focused on mental illness. OBJECTIVES The aim of this paper is to provide an overview of current research on somatic diseases of homeless people in Germany. METHODS Based on a systematic literature review for the years 2009-2019, the methodological approaches, sample access, recruitment, and health aspects reported in the studies are compared. RESULTS By means of a systematic literature search, eight peer-reviewed journal articles were identified. Often the term "homelessness" was not operationalised. The average age of homeless participants was between 40.9 years and 67 years, and the proportion of women was between 0 and 35.3%. Frequently the sample was taken from accommodation and medical services for homeless people. One recruitment strategy was "respondent-driven sampling" in conjunction with incentives. The respondents most frequently reported cardiovascular diseases (17%-37.2%), musculoskeletal diseases (≥20%), and respiratory diseases (7%-24%). Depending on the recruitment site, infectious diseases were common (tuberculosis, hepatitis B and C). CONCLUSION Somatic health studies of homeless people are often selective. Older men with lower educational backgrounds living in large German cities appear to be overrepresented, and there is no uniform use of the term "homelessness." Compared with representative population data for Germany, increased risks of somatic illness were observed; cohort characteristics can explain these to a limited extent. Biographical and intersectional approaches are needed to capture multiple and cumulative exposure situations in homelessness.
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Hanke K, Fiedler S, Grumann C, Ratmann O, Hauser A, Klink P, Meixenberger K, Altmann B, Zimmermann R, Marcus U, Bremer V, Auwärter V, Bannert N. A Recent Human Immunodeficiency Virus Outbreak Among People Who Inject Drugs in Munich, Germany, Is Associated With Consumption of Synthetic Cathinones. Open Forum Infect Dis 2020; 7:ofaa192. [PMID: 32617370 PMCID: PMC7314588 DOI: 10.1093/ofid/ofaa192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background Needle and syringe sharing among people who inject drugs (PWID) can result in a rapid regional spread of a human immunodeficiency virus (HIV) variant. Such outbreaks have been identified recently in several countries and have raised public health attention because of an association with new psychoactive substances (NPS). Methods Dried serum spots from approximately 60% of newly diagnosed HIV cases in Germany in 2013–2018 were received together with statutory notification data. Samples were sequenced in the pol-region, genotyped, and viral phylogenies were analyzed. For selected samples, the hepatitis C virus (HCV) status and the presence of NPS were determined. Results An outbreak of closely related 27 subtype C infections with a core of 11 cases with almost identical sequences was identified using phylogenetic analyses. The first case of the outbreak was diagnosed in 2015, and the last one was in 2018. With exception of 3 infections, all were reported from Munich, the capital of the federal state of Bavaria. Of 26 analyzed outbreak members, 24 (92.3%) had a resolved or viremic HCV coinfection. In 8 of 18 (44%) cases, α-pyrrolidinopentiothiophenone and/or the related substance α-pyrrolidinoheptiophenone was identified. Conclusions Despite harm reduction services in place, HIV outbreaks of considerable size can occur in PWID. The establishment of a real-time molecular surveillance is advised to rapidly identify outbreaks and target prevention measures.
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Affiliation(s)
- Kirsten Hanke
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Stefan Fiedler
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Christina Grumann
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Andrea Hauser
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Patrycja Klink
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | | | - Britta Altmann
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Division of HIV/AIDS, STI, and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ulrich Marcus
- Division of HIV/AIDS, STI, and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Division of HIV/AIDS, STI, and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Norbert Bannert
- Division of HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany.,Institute of Virology, Charité Universitätsmedizin Berlin, Berlin, Germany
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