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Popping S, Haspels S, Gotz HM, van der Meijden WCJPM, van den Elshout M, Rijnders BJ. Low Hepatitis C Virus Prevalence among Men Who Have Sex with Men Attending Public Health Services in The Netherlands. Viruses 2023; 15:2317. [PMID: 38140558 PMCID: PMC10747767 DOI: 10.3390/v15122317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
The hepatitis C virus (HCV) prevalence is high among men who have sex with men (MSM) with HIV in the Netherlands. Large reductions in HCV incidence among MSM with HIV, however, have occurred since treatment with direct-acting antivirals. Over the years, a broader understanding of the HCV epidemic has shown that HCV infections are not solely restricted to MSM with HIV, but they also occur among HIV-negative MSM. Currently, HCV testing among HIV-negative MSM is only provided for PrEP users and is not part of routine sexually transmitted infection (STI) screening among HIV-negative MSM who are not using PrEP. In this study, we screened 1885 HIV-negative MSM who did not participate in a PrEP program, with over 1966 STI screening visits at four different public health clinic sites. Among the 1885 MSM, only one person had a new HCV infection, resulting in a 0.05% (95% confidence interval 0.0-0.3) incidence. Based on our findings, we can conclude that systematic HCV testing at STI clinics may not yield significant benefits for this particular population.
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Affiliation(s)
- Stephanie Popping
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, 3015 CN Rotterdam, The Netherlands
- Centre for Experimental and Molecular Medicine (CEMM), Amsterdam University Medical Centres—Location AMC, P.O. Box 22660, 1105 AZ Amsterdam, The Netherlands
| | - Sabine Haspels
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, 3015 CN Rotterdam, The Netherlands
| | - Hannelore M. Gotz
- Department of Sexual Health, Public Health Service Rotterdam, 3011 EN Rotterdam, The Netherlands
| | | | - Mark van den Elshout
- Department of Sexual Health, Public Health Service of the Utrecht Region, 3521 AZ Utrecht, The Netherlands
| | - Bart J. Rijnders
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, 3015 CN Rotterdam, The Netherlands
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2
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Doffoel M, Ernwein F, Chaffraix F, Haumesser L, Tripon S, Bader R, Lang JP, Lang A, Paya D, Royant M, Velay-Rusch A, Tebacher M, Meyer N, Habersetzer F, Baumert T. Characteristics and care of chronic hepatitis C treated with direct-acting antivirals in migrants. Eur J Gastroenterol Hepatol 2022; 34:664-670. [PMID: 34974466 DOI: 10.1097/meg.0000000000002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Hepatitis C is poorly documented in migrants. The published studies mainly concern the screening in this population and are limited to some countries in Europe and North America. This study aimed to evaluate the characteristics and care of chronic hepatitis C in this population compared to the nonmigrant population, in the era of direct-acting antivirals (DAAs). METHOD We performed a retrospective analysis based on data presented at the multidisciplinary team meetings of our tertiary care center between 2015 and 2019. RESULTS We included 277 migrant- and 1390 nonmigrant patients mono-infected with hepatitis C virus (HCV) and treated with DAAs. The majority of the migrants were from Eastern European countries. In multivariable analysis, BMI classes associated with more obesity (OR = 1.84; 95% CI, 1.37-2.49; P < 0.001) and therapeutic patient education (OR = 3.91; 95% CI, 2.38-6.49; P < 0.001) were positively associated with migrant status, whereas age (OR = 0.92; 95% CI, 0.90-0.94; P < 0.001), female gender (OR = 0.46; 95% CI, 0.28-0.74; P = 0.002), modes of contamination with less drug use, transfusion history or nosocomial risk, as well more unknown mode (OR = 0.70; 95% CI, 0.50-0.96; P = 0.031), alcohol consumption (OR = 0.48; 95% CI, 0.29-0.73; P = 0.001), types of structures with less care in a general hospital or health network of general practitioners and more care in a university hospital or primary addictology center (OR = 0.78; 95% CI, 0.60-0.99; P = 0.046) and opioid substitution therapy (OR = 0.25; 95% CI, 0.08-0.68; P = 0.008) were negatively associated with migrant status. The substained virologic response 12 was close to 97% in both groups. CONCLUSION Despite multiple differences in characteristics and therapeutic care between the two populations, the chances of healing hepatitis C were the same among migrant- compared with nonmigrant patients.
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Affiliation(s)
- Michel Doffoel
- Service expert de lutte contre les hépatites virales d'alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | - Florence Ernwein
- Service expert de lutte contre les hépatites virales d'alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | - Frédéric Chaffraix
- Service expert de lutte contre les hépatites virales d'alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | - Lucile Haumesser
- Groupe méthode en recherche clinique, Pôle de santé publique au travail, Hôpitaux universitaires, Strasbourg, France
| | - Simona Tripon
- Service expert de lutte contre les hépatites virales d'alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | - Robert Bader
- service d'hépatogastroentérologie et médecine tropicale, Pôle pathologies digestives et urologiques, Hôpital Emile Muller, Groupement hospitalier régional mulhouse sud alsace (GHRMSA), Mulhouse
| | - Jean-Philippe Lang
- Service expert de lutte contre les hépatites virales d'alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | - Anais Lang
- Service expert de lutte contre les hépatites virales d'alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | | | - Maude Royant
- Service expert de lutte contre les hépatites virales d'alsace (SELHVA) Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | | | - Martine Tebacher
- Centre régional de pharmacovigilance grand est, Hôpitaux universitaires
| | - Nicolas Meyer
- Groupe méthode en recherche clinique, Pôle de santé publique au travail, Hôpitaux universitaires, Strasbourg, France
| | - François Habersetzer
- Service d'hépato gastroentérologie, Pôle hépato-digestif, Nouvel hôpital civil, Hôpitaux universitaires
| | - Thomas Baumert
- INSERM U-1110 Institut de recherche sur les maladies virales et hépatiques, Université de strasbourg, Strasbourg, France
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3
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Busschots D, Bielen R, Koc ÖM, Heyens L, Verrando R, de Galocsy C, Van Steenkiste C, Nevens F, Midgard H, Dalgard O, Robaeys G. Hepatitis C reinfection in former and active injecting drug users in Belgium. Harm Reduct J 2021; 18:102. [PMID: 34641896 PMCID: PMC8507240 DOI: 10.1186/s12954-021-00552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND There is currently no systematic screening for hepatitis C (HCV) reinfection in people who inject drugs (PWID) after treatment in Belgium. However, in a recent meta-analysis, the overall HCV reinfection rate was 5.9/100 person-years (PY) among PWID. Accordingly, this study was undertaken to investigate the reinfection rate in former and active PWID who achieved the end of treatment response after direct-acting antiviral (DAA) treatment in Belgium. METHODS This observational cross-sectional study recruited individuals with a history of injecting drug use who had achieved the end of treatment response to any DAA treatment between 2015 and 2020. Participants were offered a post-treatment HCV RNA test. RESULTS Eighty-five potential participants were eligible to participate and contacted, of whom 60 participants were enrolled in the study with a median age of 51.0 (IQR 44.3-56.0) years; it was reported that 23.3% continued to inject drugs intravenously after DAA treatment. Liver cirrhosis was present in 12.9%. The majority had genotype 1a (51.7%) or genotype 3 (15.0%) infection. We detected no reinfections in this study population. The total time patients were followed up for reinfection in the study was 78.5 PY (median 1.0 years IQR 0.4-2.0). CONCLUSION Reinfection after successful treatment with DAA initially appears to be very low in Belgian PWID. Therefore, efforts should be made to screen individuals with persistent risk behaviors for reinfection systematically. In addition, a national HCV registry should be established to accurately define the burden of HCV infection and reinfection in Belgium and support the elimination of viral hepatitis C in Europe. Trial registration clinicaltrials.gov NCT04251572, Registered 5 Feb 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04251572 .
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Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Diepenbeek, 3500, Hasselt, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Diepenbeek, 3500, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Özgür M Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Diepenbeek, 3500, 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, Martelarenlaan 42, Diepenbeek, 3500, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,School of NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU, Leuven, Belgium
| | - Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Diepenbeek, 3500, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU, Leuven, Belgium
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Sperle I, Nielsen S, Bremer V, Gassowski M, Brummer-Korvenkontio H, Bruni R, Ciccaglione AR, Kaneva E, Liitsola K, Naneva Z, Perchemlieva T, Spada E, Toikkanen SE, Amato-Gauci AJ, Duffell E, Zimmermann R. Developing and Piloting a Standardized European Protocol for Hepatitis C Prevalence Surveys in the General Population (2016-2019). Front Public Health 2021; 9:568524. [PMID: 34123980 PMCID: PMC8193123 DOI: 10.3389/fpubh.2021.568524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/28/2021] [Indexed: 12/09/2022] Open
Abstract
Background: A robust estimate of the number of people with chronic hepatitis C virus (HCV) infection is essential for an appropriate public health response and for monitoring progress toward the WHO goal of eliminating viral hepatitis. Existing HCV prevalence studies in the European Union (EU)/European Economic Area (EEA) countries are heterogeneous and often of poor quality due to non-probability based sampling methods, small sample sizes and lack of standardization, leading to poor national representativeness. This project aimed to develop and pilot standardized protocols for undertaking nationally representative HCV prevalence surveys in the general adult population. Methods: From 2016 to 2019 a team from the Robert Koch-Institute contracted by the European Centre for Disease Prevention and Control synthesized evidence on existing HCV prevalence surveys and survey methodology and drafted a protocol. The methodological elements of the protocol were piloted and evaluated in Bulgaria, Finland and Italy, and lessons learnt from the pilots were integrated in the final protocol. An international multidisciplinary expert group was consulted regularly. Results: The protocol includes three alternative study approaches: a stand-alone survey; a "nested" survey within an existing health survey; and a retrospective testing survey approach. A decision algorithm advising which approach to use was developed. The protocol was piloted and finalized covering minimum and gold standards for all steps to be implemented from sampling, data protection and ethical issues, recruitment, specimen collection and laboratory testing options, staff training, data management and analysis and budget considerations. Through piloting, the survey approaches were effectively implemented to produce HCV prevalence estimates and the pilots highlighted the strengths and limitations of each approach and key lessons learnt were used to improve the protocol. Conclusions: An evidence-based protocol for undertaking HCV prevalence serosurveys in the general population reflecting the different needs, resources and epidemiological situations has been developed, effectively implemented and refined through piloting. This technical guidance supports EU/EEA countries in their efforts to estimate their national hepatitis C burden as part of monitoring progress toward the elimination targets.
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Affiliation(s)
- Ida Sperle
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- Charité, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Martyna Gassowski
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Roberto Bruni
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | | | - Elena Kaneva
- Regional Health Inspectorate, Stara Zagora, Bulgaria
| | - Kirsi Liitsola
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Enea Spada
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Salla E. Toikkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Erika Duffell
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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5
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Hussein NR, Daniel S, Mirkhan SA, Saleem ZSM, Musa DH, Ibrahim N, Naqid IA. Impact of the Covid-19 pandemic on the elimination of hepatitis C virus in Duhok, Kurdistan, Iraq: A retrospective cross-sectional study. J Family Med Prim Care 2021; 9:6213-6216. [PMID: 33681066 PMCID: PMC7928153 DOI: 10.4103/jfmpc.jfmpc_1675_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/26/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Aim Infection with hepatitis C virus (HCV) is a public health threat worldwide. The World Health Organization aims to eliminate HCV. However, the coronavirus disease (COVID-19) pandemic has led to a severe compromise in health services, and this has halted efforts to eliminate HCV. Herein, we report our experience with the initiative of HCV elimination in Duhok city, Kurdistan Region of Iraq, with a focus on the effect of the COVID-19 pandemic on the HCV elimination plan. Materials and Methods An anti-HCV antibody test was used to screen subjects. All positive results were then confirmed by reverse-transcription polymerase chain reaction (RT-PCR) testing. All patients with current HCV infection were treated with direct-acting antiviral regimens. Results During the study period, 459,015 subjects were tested for anti-HCV antibody positivity, with a monthly average of 9,562 tests for HCV. This number dropped to zero during the lockdown period between 1March and 31May 2020. Among the tested samples, 0.29% (1350/459015) tested positive for anti-HCV antibodies. RT-PCR testing of all positive samples revealed that 0.020% (93/459015) were positive. Of the 93 recruited subjects, 3 patients did not complete the treatment course due to the lockdown. All patients who finished the treatment course were cured as determined by sustained virologic response 12 (SVR12) weeks after finishing the treatment course. Conclusion During the COVID-19 pandemic, reductions in health facility utilisation led to a significant decrease in services offered for HCV screening and treatment. Such a decrease in services has had a negative impact on HCV elimination. An urgent plan is needed to resume the services, and strict follow-up is needed for patients whose treatment was interrupted.
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Affiliation(s)
- Nawfal R Hussein
- Department of Biomedical Science, College of Medicine, University of Zakho, Kurdistan Region, Iraq
| | - Shameran Daniel
- Basic Sciences Department, College of Dentistry, University of Duhok, Kurdistan Region, Iraq
| | | | | | - Dildar H Musa
- College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Nashwan Ibrahim
- College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Ibrahim A Naqid
- Department of Biomedical Science, College of Medicine, University of Zakho, Kurdistan Region, Iraq
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Eijsink JFH, Al Khayat MNMT, Boersma C, Ter Horst PGJ, Wilschut JC, Postma MJ. Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:75-88. [PMID: 33064259 PMCID: PMC7561704 DOI: 10.1007/s10198-020-01236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The prevalence of diagnosed chronic hepatitis C virus (HCV) infection among pregnant women in the Netherlands is 0.26%, yet many cases remain undiagnosed. HCV screening and treatment of pregnant HCV carriers could reduce the burden of disease and limit vertical transmission from mother to child. We assessed the impact of HCV screening and subsequent treatment with new direct-acting antivirals (DAAs) among pregnant women in the Netherlands. METHODS An HCV natural history Markov transition state model was developed, to evaluate the public-health and economic impact of HCV screening and treatment. Besides all 179,000 pregnant women in the Netherlands (cohort 1), we modelled 3 further cohorts: all 79,000 first-time pregnant women (cohort 2), 33,000 pregnant migrant women (cohort 3) and 16,000 first-time pregnant migrant women (cohort 4). Each cohort was analyzed in various scenarios: i no intervention, i.e., the current practice, ii screen-and-treat, i.e., the most extensive approach involving treatment of all individuals found HCV-positive, and iii screen-and-treat/monitor, i.e., a strategy involving treatment of symptomatic (F1-F4) patients and follow-up of asymptomatic (F0) HCV carriers with subsequent treatment only at progression. RESULTS For all cohorts, comparison between scenarios (ii) and (i) resulted in ICERs between €9,306 and €10,173 per QALY gained and 5 year budget impacts varying between €6,283,830 and €19,220,405. For all cohorts, comparison between scenarios (iii) and (i) resulted in ICERs between €1,739 and €2,749 per QALY gained and budget impacts varying between €1,468,670 and €5,607,556. For all cohorts, the ICERs (scenario iii versus ii) involved in delayed treatment of asymptomatic (F0) HCV carriers varied between €56,607 and €56,892, well above the willingness-to-pay (WTP) threshold of €20,000 per QALY gained and even above a threshold of €50,000 per QALY gained. CONCLUSION Universal screening for HCV among all pregnant women in the Netherlands is cost-effective. However, it would be reasonable to consider smaller risk groups in view of the budget impact of the intervention.
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Affiliation(s)
- Job F H Eijsink
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute Pharmacy, University of Groningen, Groningen, The Netherlands.
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of Clinical Pharmacy, Isala, Zwolle, The Netherlands.
| | - Mohamed N M T Al Khayat
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cornelis Boersma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Khudhair HAA, Albakaa AAH, Hussein KR. Detection the Prevalence of Hepatitis C Virus among Iraqi People.. [DOI: 10.1101/2020.11.28.401968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
ABSTRACTHepatitis C virus (HCV) infection is a major public health problem worldwide and remains a vital cause of chronic hepatitis. This study was aimed to detect the prevalence of HCV infection among Iraqi people. Four subjects of hemodialysis (HD) patients, thalassemia patients, blood donors and medical staff were enrolled in this study and evaluated for their serum anti-HCV-immunoglobulin G (IgG)-antibodies (Abs). The total frequency % of IgG anti-HCV Abs positivity was 3.2%, in which the highest frequency % was recorded among thalassemia patients followed by HD patients and then medical staff subjects, whereas the lowest frequency rate was reported within blood donors group. The frequencies of IgG anti-HCV Abs positivity were significantly elevated in males compared to females. For age groups, the results revealed higher infection rate of HCV among age group of 1-20 year followed by the age group of 21-40 year and then age group of 41-60 year, whereas the lowest rate of infection was recorded in age group >60 year. In conclusions, the prevalence rate of HCV infection among Iraqi people is similar to those in most of Asian and non-Asian studied populations and the infection rate was higher in males and inversely correlated with age of the patients. Blood transfusion, renal dialysis and health care workers (HCWs) were major sources of HCV infection. Thus, we recommend continuing surveillance of blood donors, HCWs and patients, in addition to HCV markers screening by molecular technique for the diagnosis of HCV during the window period in order to decrease the prevalence of HCV infection.
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8
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Chronic hepatitis B and C infections in the Netherlands: estimated prevalence in risk groups and the general population. Epidemiol Infect 2020; 147:e147. [PMID: 30869044 PMCID: PMC6518512 DOI: 10.1017/s0950268819000359] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are usually asymptomatic for decades, thus targeted screening can prevent liver disease by timely diagnosis and linkage to care. More robust estimates of chronic HBV and HCV infections in the general population and risk groups are needed. Using a modified workbook method, the total number of ever chronically infected individuals in the Netherlands in 2016 was determined using population size and prevalence estimates from studies in the general and high-risk population. The estimated 2016 chronic HBV infection prevalence is 0.34% (low 0.22%, high 0.47%), corresponding to approximately 49 000 (low 31 000, high 66 000) HBV-infected individuals aged 15 years and older. The estimated ever-chronic HCV infection prevalence is 0.16% (low 0.06%, high 0.27%), corresponding to approximately 23 000 (low 8000, high 38 000) ever-chronic HCV-infected individuals. The prevalence of chronic HBV and HCV infections in the Netherlands is low. First-generation migrants account for most infections with 81% and 60% of chronic HBV and HCV infections, respectively. However, about one-fifth of HCV infections is found in the general population at low risk. This method can serve as an example for countries in need of more accurate prevalence estimates, to help the design and evaluation of prevention and control policies.
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Trickey A, Fraser H, Lim AG, Walker JG, Peacock A, Colledge S, Leung J, Grebely J, Larney S, Martin NK, Degenhardt L, Hickman M, May MT, Vickerman P. Modelling the potential prevention benefits of a treat-all hepatitis C treatment strategy at global, regional and country levels: A modelling study. J Viral Hepat 2019; 26:1388-1403. [PMID: 31392812 PMCID: PMC10401696 DOI: 10.1111/jvh.13187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
Abstract
The World Health Organization (WHO) recently produced guidelines advising a treat-all policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional and global levels. We assessed what country-level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN data sets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies; either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20 years. Linear regression was used to identify associations between IA per treatment and demographic factors. Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20 years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35 and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68-2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country's population growth rate and negatively associated with higher HCV prevalence among PWID. In conclusion, appreciable prevention benefits could be achieved from WHO's treat-all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Janni Leung
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.,Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Jason Grebely
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States.,The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Population Health Sciences, University of Bristol, Bristol, UK.,Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK
| | - Margaret T May
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, UK
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10
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Bil JP, Schrooders PA, Prins M, Kouw PM, Klomp JH, Scholing M, Huijbregts LP, Sonder GJ, Waegemaekers TC, de Vries HJ, Meijer W, Zuure FR, Tostmann A. Integrating hepatitis B, hepatitis C and HIV screening into tuberculosis entry screening for migrants in the Netherlands, 2013 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29560855 PMCID: PMC5861593 DOI: 10.2807/1560-7917.es.2018.23.11.17-00491] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We evaluated uptake and diagnostic outcomes of voluntary hepatitis B (HBV) and C virus (HCV) screening offered during routine tuberculosis entry screening to migrants in Gelderland and Amsterdam, the Netherlands, between 2013 and 2015. In Amsterdam, HIV screening was also offered. Overall, 54% (461/859) accepted screening. Prevalence of chronic HBV infection (HBsAg-positive) and HCV exposure (anti-HCV-positive) in Gelderland was 4.48% (9/201; 95% confidence interval (CI): 2.37–8.29) and 0.99% (2/203; 95% CI: 0.27–3.52), respectively, all infections were newly diagnosed. Prevalence of chronic HBV infection, HCV exposure and chronic HCV infection (HCV RNA-positive) in Amsterdam was 0.39% (1/256; 95% CI: 0.07–2.18), 1.17% (3/256; 95% CI: 0.40–3.39) and 0.39% (1/256; 95% CI: 0.07–2.18), respectively, with all chronic HBV/HCV infections previously diagnosed. No HIV infections were found. In univariate analyses, newly diagnosed chronic HBV infection was more likely in participants migrating for reasons other than work or study (4.35% vs 0.83%; odds ratio (OR) = 5.45; 95% CI: 1.12–26.60) and was less likely in participants in Amsterdam than Gelderland (0.00% vs 4.48%; OR = 0.04; 95% CI: 0.00–0.69). Regional differences in HBV prevalence might be explained by differences in the populations entering compulsory tuberculosis screening. Prescreening selection of migrants based on risk factors merits further exploration.
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Affiliation(s)
- Janneke P Bil
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Peter Ag Schrooders
- Department of Infectious Diseases, Public Health Service of Noord- en Oost-Gelderland, Warnsveld, the Netherlands
| | - Maria Prins
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Peter M Kouw
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Judith He Klomp
- Department of Infectious Diseases, Public Health Service of Gelderland Zuid, Nijmegen, the Netherlands
| | - Maarten Scholing
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Lutje Phm Huijbregts
- Department of Infectious Diseases, Public Health Service of Noord- en Oost-Gelderland, Warnsveld, the Netherlands
| | - Gerard Jb Sonder
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Toos Chfm Waegemaekers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Henry Jc de Vries
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Wieneke Meijer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Freke R Zuure
- These authors share joint last authorship.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Alma Tostmann
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,These authors share joint last authorship
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11
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Geenen JW, Boersma C, Klungel OH, Hövels AM. Accuracy of budget impact estimations and impact on patient access: a hepatitis C case study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:857-867. [PMID: 30953216 PMCID: PMC6652171 DOI: 10.1007/s10198-019-01048-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/28/2019] [Indexed: 05/08/2023]
Abstract
BACKGROUND High budget impact (BI) estimates of new drugs limit access to patients due to concerns regarding affordability and displacement effects. The accuracy and methodological quality of BI analyses are often low, potentially mis-informing reimbursement decision making. Using hepatitis C as a case study, we aim to quantify the accuracy of the BI predictions used in Dutch reimbursement decision-making and to characterize the influence of market-dynamics on actual BI. METHODS We selected hepatitis C direct-acting antivirals (DAAs) that were introduced in the Netherlands between January 2014 and March 2018. Dutch National Health Care Institute (ZIN) BI estimates were derived from the reimbursement dossiers. Actual Dutch BI data were provided by FarmInform. BI prediction accuracy was assessed by comparing the ZIN BI estimates with the actual BI data. RESULTS Actual BI, from 1 Jan 2014 to 1 March 2018, was €248 million whilst the BI estimates ranged from €388-€510 million. The latter figure represents the estimated BI for the reimbursement scenario that was adopted, implying a €275 million overestimation. Absent incorporation of timing of regulatory decisions and inadequate correction for the introduction of new products were main drivers of BI overestimation, as well as uncertainty regarding the patient population size and the impact of the final reimbursement decision. DISCUSSION BI in reimbursement dossiers largely overestimated actual BI of hepatitis C DAAs. When BI analysis is performed according to existing guidelines, the resulting more accurate BI estimates may lead to better informed reimbursement decisions.
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Affiliation(s)
- Joost W Geenen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584CG, Utrecht, The Netherlands
| | - Cornelis Boersma
- Division of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
- Health-Ecore, 1e Hogeweg 196, 3701 HL, Zeist, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584CG, Utrecht, The Netherlands.
| | - Anke M Hövels
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584CG, Utrecht, The Netherlands
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12
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Trickey A, Fraser H, Lim AG, Peacock A, Colledge S, Walker JG, Leung J, Grebely J, Larney S, Martin NK, Hickman M, Degenhardt L, May MT, Vickerman P. The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study. Lancet Gastroenterol Hepatol 2019; 4:435-444. [PMID: 30981685 PMCID: PMC6698583 DOI: 10.1016/s2468-1253(19)30085-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND WHO aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030. Injection drug use is an important risk factor for HCV transmission, but its contribution to country-level and global epidemics is unknown. We estimated the contribution of injection drug use to risk for HCV epidemics globally, regionally, and at country level. METHODS We developed a dynamic deterministic HCV transmission model to simulate country-level HCV epidemics among people who inject drugs and the general population. Each country's model was calibrated using country-specific data from UN datasets and systematic reviews on the prevalence of HCV and injection drug use. The population attributable fraction of HCV transmission associated with injection drug use was estimated-defined here as the percentage of HCV infections prevented if additional HCV transmission due to injection drug use was removed between 2018 and 2030. FINDINGS The model included 88 countries (85% of the global population). The model predicted 0·23% (95% credibility interval [CrI] 0·16-0·31) of the global population were injection drug users in 2017, and 8% (5-12) of prevalent HCV infections were among people who currently inject drugs. Globally, if the increased risk for HCV transmission among people who inject drugs was removed, an estimated 43% (95% CrI 25-67) of incident HCV infections would be prevented from 2018 to 2030, varying regionally. This population attributable fraction was higher in high-income countries (79%, 95% CrI 57-97) than in countries of low and middle income (38%, 24-64) and was associated with the percentage of a country's prevalent HCV infections that are among people who inject drugs. INTERPRETATION Unsafe injecting practices among people who inject drugs contribute substantially to incident HCV infections globally. Any intervention that can reduce HCV transmission among people who inject drugs will have a pronounced effect on country-level incidence of HCV. FUNDING None.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK.
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | | | - Janni Leung
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Centre for Youth Substance Abuse Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jason Grebely
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Population Health Sciences, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Margaret T May
- Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, UK
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13
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Edmunds BL, Miller ER, Tsourtos G. The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010-2016. BMC Public Health 2019; 19:527. [PMID: 31068170 PMCID: PMC6505114 DOI: 10.1186/s12889-019-6847-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus infection (HCV) is a communicable disease of increasing global importance with 1.75 million new infections and 400,000 related deaths annually. Until recently, treatment options have had low uptake and most infected people remain untreated. New Direct Acting Antiviral medications can clear the virus in around 95% of cases, with few side-effects. These medications are restricted in most countries but freely accessible in Australia, yet most people still remain untreated. This study applies a cross-sectional research design to investigate the socio-spatial distribution of HCV in South Australia, to identify vulnerable populations, and examine epidemiological factors to potentially inform future targeted strategies for improved treatment uptake. METHOD HCV surveillance data were sourced from South Australia's Communicable Diseases Control Branch and socio-economic population data from the Australian Bureau of Statistics from January 2010 to December 2016 inclusive. HCV cases were spatially mapped at postcode level. Multivariate logistic regression identified independent predictors of demographic risks for HCV notification and notification source. RESULTS HCV notifications (n = 3356) were seven times more likely to be from people residing in the poorest areas with high rates of non-employment (75%; n = 1876) and injecting drug use (74%; n = 1862) reported. Notifications among Aboriginal and Torres Strait Islander people were around six times that of non-Indigenous people. HCV notifications negatively correlated (Spearman's rho - 0.426; p < 0.001) with socio-economic status (residential postcode socio-economic resources Index). History of imprisonment independently predicted HCV diagnoses in lesser economically-resourced areas (RR1.5; p < 0.001). Independent predictors of diagnosis elsewhere than in general practices were non-employment (RR 4.6; p = 0.028), being male (RR 2.5; p < 0.001), and younger than mean age at diagnosis (RR 2.1; p = 0.006). CONCLUSIONS Most people diagnosed with HCV were from marginalised sub-populations. Given general practitioners are pivotal to providing effective HCV treatment for many people in Australia a most concerning finding was that non-employed people were statistically less likely to be diagnosed by general practitioners. These findings highlight a need for further action aimed at improving healthcare access and treatment uptake to help reduce the burden of HCV for marginalised people, and progress the vision of eliminating HCV as a major public health threat.
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Affiliation(s)
| | - Emma Ruth Miller
- Flinders University, GPO Box 2100, Adelaide, 5001 South Australia
| | - George Tsourtos
- Flinders University, GPO Box 2100, Adelaide, 5001 South Australia
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14
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Kracht PAM, Arends JE, van Erpecum KJ, Thijsen SFT, Vlaminckx BJM, Weersink AJL, Wensing AMJ, Deege MPH, Dimmendaal M, Stadhouders PHGM, Friederich PW, Verhagen MAMT, Boland GJ, Hoepelman AIM. REtrieval And cure of Chronic Hepatitis C (REACH): Results of micro-elimination in the Utrecht province. Liver Int 2019; 39:455-462. [PMID: 30204289 DOI: 10.1111/liv.13959] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/13/2018] [Accepted: 09/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Netherlands is one of the six European countries considered on track to eliminate hepatitis C virus by 2030. To achieve this goal, continuous efforts have to be put into designing efficient case-finding strategies, including the retrieval of previously diagnosed hepatitis C virus-infected who are lost to follow-up. AIMS To trace and treat all lost to follow-up hepatitis C virus patients in the Utrecht region and create an efficient retrieval strategy that can be used in future (national) retrieval initiatives. METHODS Positive hepatitis C virus diagnostic tests (anti-hepatitis C virus IgG or hepatitis C virus-RNA) from the laboratory of all four hospitals and one central laboratory for primary care diagnostics in the province of Utrecht from 2001 to 2015 were linked to clinical records. Untreated patients with available contact information were deemed eligible for retrieval and invited for reevaluation with (virology) blood tests, fibroscan measurement and possible direct-acting antiviral therapy. MAIN RESULTS After screening all hepatitis C virus diagnostics, 1913 chronic hepatitis C virus-infected were identified of which 14.1% (n = 269) were invited back into care. Overall, 17.4% was traced with the highest yield (28.3%) in those who lived in the Utrecht province. Through renewed patient assessments, 42 chronic hepatitis C virus infections were re-identified (76% with a history of intravenous drug use, 24% with Metavir F3-F4). Until now, 59% has either scheduled or initiated direct-acting antiviral therapy. CONCLUSION The retrieval of previously diagnosed hepatitis C virus patients through screening of laboratory diagnostics from the past is feasible and should be pursued for further control and reduction of hepatitis C virus infection. Retrieval is most successful when performed regionally. LAY SUMMARY To completely eliminate chronic hepatitis C virus (HCV) infection and prevent complications, undiagnosed and also previously diagnosed but lost to follow-up (LFU) HCV patients have to be brought (back) into care for therapy. Retrieval of LFU HCV patients through screening of laboratory diagnostics from the past is feasible and most successful when performed regionally.
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Affiliation(s)
- Patricia A M Kracht
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joop E Arends
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karel J van Erpecum
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Anne M J Wensing
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | | | - Greet J Boland
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andy I M Hoepelman
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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Henriquez-Camacho C, Serre N, Norman F, Sánchez-Montalvá A, Torrús D, Goikoetxea AJ, Herrero-Martínez JM, Ruiz-Giardín JM, Treviño B, Monge-Maillo B, Molina I, Rodríguez A, García M, López-Vélez R, Pérez-Molina JA. Clinicoepidemiological characteristics of viral hepatitis in migrants and travellers of the +Redivi network. Travel Med Infect Dis 2019; 29:51-57. [PMID: 30738196 DOI: 10.1016/j.tmaid.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Continuous growth of mobile populations has influenced the global epidemiology of infectious diseases, including chronic and acute viral hepatitis. METHOD A prospective observational multicentre study was performed in a Spanish network of imported infections. Viral hepatitis cases from January 2009 to September 2017 were included. RESULTS Of 14,546 records, 723 (4.97%) had imported viral hepatitis, including 48 (6.64%) acute cases and 675 (93.36%) chronic cases. Of the 48 acute cases, 31 were travellers and immigrants returning from visiting friends or relatives (VFR), while 19 (61%) were acute Hepatitis A or Hepatitis B. Only 18.2% of VFR immigrants and 35% of travellers received pre-travel advice. Acute hepatitis was more frequent in VFR immigrants (AOR 2.59, CI95% 1.20-5.60) and travellers (AOR 2.83, CI95% 1.46-5.50) than immigrants. Of the 675 Chronic cases, 570 were immigrants, and 439 (77%) had chronic Hepatitis B. Chronic hepatitis was more frequent in immigrants (AOR 20.22, CI95% 11.64-35.13) and VFR immigrants (AOR 11.12, CI95% 6.20-19.94) than travellers. CONCLUSIONS Chronic viral hepatitis was typical of immigrants, acute viral hepatitis was common among travellers, and VFR immigrants had mixed risk. Improving pre-travel consultation and screening of immigrants may contribute to preventing new cases of viral hepatitis and avoiding community transmission.
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Affiliation(s)
- Cesar Henriquez-Camacho
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - Núria Serre
- Unitat Medicina Tropical I Salut Internacional Vall d´Hebron-Drassanes, PROSICS, Av de Drassanes 17-21, 08001, Barcelona, Spain
| | - Francesca Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d´Hebron University Hospital, Universitat Autonoma de Barcelona, PROSICS Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain
| | - Diego Torrús
- Alicante University Hospital, Calle Pintor Baeza 11, 03010, Alicante, Spain
| | | | | | | | - Begoña Treviño
- Unitat Medicina Tropical I Salut Internacional Vall d´Hebron-Drassanes, PROSICS, Av de Drassanes 17-21, 08001, Barcelona, Spain
| | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d´Hebron University Hospital, Universitat Autonoma de Barcelona, PROSICS Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain
| | - Azucena Rodríguez
- Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011, Oviedo Principado de Asturias, Spain
| | - Magdalena García
- Consorcio Hospital General Universitario de Valencia, Avenida Tres Cruces, 2, 46014, Valencia, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain
| | - José A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Carretera de Colmenar Km 9, 1, 28034, Madrid, Spain.
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16
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Litzroth A, Suin V, Wyndham-Thomas C, Quoilin S, Muyldermans G, Vanwolleghem T, Kabamba-Mukadi B, Verburgh V, Jacques M, Van Gucht S, Hutse V. Low hepatitis C prevalence in Belgium: implications for treatment reimbursement and scale up. BMC Public Health 2019; 19:39. [PMID: 30621662 PMCID: PMC6325873 DOI: 10.1186/s12889-018-6347-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/19/2018] [Indexed: 01/20/2023] Open
Abstract
Background Prevalence data of chronic hepatitis C virus (HCV) infection are needed to estimate the budgetary impact of reimbursement of direct-acting antivirals (DAAs). In Belgium, the restricted reimbursement criteria are mainly guided by regional seroprevalence estimates of 0.87% from 1993 to 1994. In this first Belgian nationwide HCV prevalence study, we set out to update the seroprevalence and prevalence of chronic HCV infection estimates in the Belgian general population in order to guide decisions on DAA reimbursement. Methods Residual sera were collected through clinical laboratories. We collected data on age, sex and district. HCV antibody status was determined with ELISA and confirmed with a line-immunoassay (LIA). In specimens with undetermined or positive LIA result, HCV viral load was measured. Specimens were classified seronegative, seropositive with resolved infection, indicative of chronic infection and with undetermined HCV status according to the test outcomes. Results were standardized for age, sex and population per district, and adjusted for clustered sampling. Results In total 3209 specimens, collected by 28 laboratories, were tested. HCV seropositivity in the Belgian general population was estimated to be 0.22% (95% CI: 0.09–0.54%), and prevalence of chronic HCV infection 0.12% (95% CI: 0.03–0.41). In individuals of 20 years and older, these estimates were 0.26% (95% CI: 0.10–0.64%) and 0.13% (95% CI: 0.04–0.43), respectively. Of the total estimated number of HCV seropositive individuals in Belgium, 66% were between 50 and 69 years old. Conclusions Prevalence of HCV seropositivity and chronic infection in the Belgian general population were low and comparable to many surrounding countries. These adjusted prevalences can help estimate the cost of reimbursement of DAAs and invite Belgian policy makers to accelerate the scaling up of reimbursement, giving all chronically infected HCV patients a more timely access to treatment.
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Affiliation(s)
- Amber Litzroth
- Scientific directorate Epidemiology and public health, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium.
| | - Vanessa Suin
- Scientific directorate Infectious diseases in humans, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
| | - Chloé Wyndham-Thomas
- Scientific directorate Epidemiology and public health, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
| | - Sophie Quoilin
- Scientific directorate Epidemiology and public health, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
| | - Gaëtan Muyldermans
- Scientific directorate Epidemiology and public health, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
| | - Thomas Vanwolleghem
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken Building S, Universiteitsplein 1, 2610, Wilrijk, Belgium.,Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Benoît Kabamba-Mukadi
- Microbiology department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Vera Verburgh
- Scientific directorate Infectious diseases in humans, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
| | - Marjorie Jacques
- Scientific directorate Infectious diseases in humans, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
| | - Steven Van Gucht
- Scientific directorate Infectious diseases in humans, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
| | - Veronik Hutse
- Scientific directorate Infectious diseases in humans, Sciensano, Juliette Wytsmanstreet 14, 1050, Brussels, Belgium
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17
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Kracht PAM, Arends JE, van Erpecum KJ, Urbanus A, Willemse JA, Hoepelman AIM, Croes EA. Strategies for achieving viral hepatitis C micro-elimination in the Netherlands. HEPATOLOGY, MEDICINE AND POLICY 2018; 3:12. [PMID: 30288334 PMCID: PMC6162944 DOI: 10.1186/s41124-018-0040-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/20/2018] [Indexed: 12/12/2022]
Abstract
The Netherlands is striving to achieve national elimination of the hepatitis C virus (HCV) as one of the first countries worldwide. The favorable HCV epidemiology with both low prevalence and incidence, together with access to care and treatment, present excellent conditions to further build on towards this objective. The Dutch national plan on viral hepatitis, introduced in 2016, defines targets in the HCV healthcare cascade and provides a structural framework for the development of elimination activities. Since many different stakeholders are involved in HCV care in the Netherlands, focus has been placed on micro-elimination initiatives as a pragmatic and efficient approach. These numerous micro-eliminations projects have brought the Netherlands closer to HCV elimination. In the near future, efforts specifically have to be made in order to optimize case-finding strategies and to successfully accomplish the nationwide implementation of the registration and monitoring system of viral hepatitis mono-infections, before this final goal can be reached. The upcoming years will then elucidate if the Dutch' hands on approach has resulted in sufficient progress against HCV and if the Netherlands will lead the way towards nationwide HCV elimination.
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Affiliation(s)
- P. A. M. Kracht
- Department of Internal medicine and Infectious disease, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. E. Arends
- Department of Internal medicine and Infectious disease, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K. J. van Erpecum
- Department of Gastroenterology and Hepatology, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A. Urbanus
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J. A. Willemse
- Dutch Liver Patient Association (NLV), Hoogland, the Netherlands
| | - A. I. M. Hoepelman
- Department of Internal medicine and Infectious disease, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E. A. Croes
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, the Netherlands
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18
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Garvey P, O'Grady B, Franzoni G, Bolger M, Irwin Crosby K, Connell J, Burke D, De Gascun C, Thornton L. Hepatitis C virus seroprevalence and prevalence of chronic infection in the adult population in Ireland: a study of residual sera, April 2014 to February 2016. ACTA ACUST UNITED AC 2018; 22:30579. [PMID: 28797323 PMCID: PMC5553053 DOI: 10.2807/1560-7917.es.2017.22.30.30579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/17/2017] [Indexed: 01/09/2023]
Abstract
Robust data on hepatitis C virus (HCV) population prevalence are essential to inform national HCV services. In 2016, we undertook a survey to estimate HCV prevalence among the adult population in Ireland. We used anonymised residual sera available at the National Virus Reference Laboratory. We selected a random sample comprising persons ≥ 18 years with probability proportional to the general population age-sex distribution. Anti-HCV and HCV Ag were determined using the Architect anti-HCV and HCV Ag assays. Fifty-three of 3,795 specimens were seropositive (age-sex-area weighted seroprevalence 0.98% (95% confidence interval (CI): 0.73–1.3%)). Thirty-three specimens were HCV-antigen and antibody-positive (age-sex-area weighted prevalence of chronic infection 0.57% (95% CI: 0.40–0.81%)). The prevalence of chronic infection was higher in men (0.91%; 95% CI: 0.61–1.4%), in specimens from the east of the country (1.4%; 95%CI: 0.99–2.0%), and among persons aged 30–39 years and 40–49 years (1.1% (95% CI: 0.59–2.0%) and 1.1% (95% CI: 0.64–1.9%) respectively). Ireland ranks at the lower end of the spectrum of prevalence of chronic HCV infection internationally. Men born between 1965 and 1984 from the east of the country have the highest rate of chronic HCV infection.
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Affiliation(s)
- Patricia Garvey
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Brian O'Grady
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Geraldine Franzoni
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Maeve Bolger
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Katie Irwin Crosby
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Deirdre Burke
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Cillian De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Lelia Thornton
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
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19
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Boerekamps A, van den Berk GE, Lauw FN, Leyten EM, van Kasteren ME, van Eeden A, Posthouwer D, Claassen MA, Dofferhoff AS, Verhagen DWM, Bierman WF, Lettinga KD, Kroon FP, Delsing CE, Groeneveld PH, Soetekouw R, Peters EJ, Hullegie SJ, Popping S, van de Vijver DAMC, Boucher CA, Arends JE, Rijnders BJ. Declining Hepatitis C Virus (HCV) Incidence in Dutch Human Immunodeficiency Virus-Positive Men Who Have Sex With Men After Unrestricted Access to HCV Therapy. Clin Infect Dis 2017; 66:1360-1365. [DOI: 10.1093/cid/cix1007] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/13/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
- Anne Boerekamps
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam
| | | | - Fanny N Lauw
- Department of Internal Medicine and Infectious Diseases, Slotervaart MC, Amsterdam
| | - Eliane M Leyten
- Department of Internal Medicine and Infectious Diseases, MC Haaglanden, Den Haag
| | - Marjo E van Kasteren
- Department of Internal Medicine and Infectious Diseases, Elisabeth-TweeSteden Ziekenhuis, Tilburg
| | - Arne van Eeden
- Department of Internal Medicine and Infectious Diseases, DC Klinieken, Amsterdam
| | - Dirk Posthouwer
- Department of Internal Medicine and Infectious Diseases, Maastricht Universitair Medisch Centrum+
| | - Mark A Claassen
- Department of Internal Medicine and Infectious Diseases, Rijnstate Ziekenhuis, Arnhem
| | - Anton S Dofferhoff
- Department of Internal Medicine and Infectious Diseases, Radboud Universitair Medisch Centrum, Nijmegen
| | | | - Wouter F Bierman
- Department of Internal Medicine and Infectious Diseases, Universitair Medisch Centrum Groningen
| | - Kamilla D Lettinga
- Department of Internal Medicine and Infectious Diseases, OLVG West, Amsterdam
| | - Frank P Kroon
- Department of Internal Medicine and Infectious Diseases, Leids Universitair Medisch Centrum, Leiden
| | - Corine E Delsing
- Department of Internal Medicine and Infectious Diseases, Medisch Spectrum Twente, Enschede
| | - Paul H Groeneveld
- Department of Internal Medicine and Infectious Diseases, Isala Ziekenhuis, Zwolle
| | - Robert Soetekouw
- Department of Internal Medicine and Infectious Diseases, Spaarne Gasthuis, Haarlem
| | - Edgar J Peters
- Department of Internal Medicine and Infectious Diseases, VU Medisch Centrum, Amsterdam
| | | | | | | | | | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, Universitair Medisch Centrum Utrecht, the Netherlands
| | - Bart J Rijnders
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam
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20
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Falla AM, Veldhuijzen IK, Ahmad AA, Levi M, Hendrik Richardus J. Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries. Eur J Public Health 2017; 27:302-306. [PMID: 27542982 PMCID: PMC5444238 DOI: 10.1093/eurpub/ckw100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background To investigate access to treatment for chronic hepatitis B/C among six vulnerable patient/population groups at-risk of infection: undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs (PWID) and people abusing alcohol. Methods An online survey among experts in gastroenterology, hepatology and infectious diseases in 2012 in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. A four-point ordinal scale measured access to treatment (no, some, significant or complete restriction). Results From 235 recipients, 64 responses were received (27%). Differences in access between and within countries were reported for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for PWID. Significant/complete treatment restriction was reported for all groups by the majority in Hungary and Spain, while Italian respondents reported no/few restrictions. Significant/complete restriction was reported for undocumented migrants and people without health insurance in the UK and Spain. Opinion about undocumented migrants in Germany and the Netherlands was divergent. Conclusions Although effective chronic hepatitis B/C treatment exists, limited access among vulnerable patient populations was seen in all study countries. Discordance of opinion about restrictions within countries is seen, especially for groups for whom the health care system determines treatment access, such as undocumented migrants, asylum seekers and people without health insurance. This suggests low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality.
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Affiliation(s)
- Abby M Falla
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Irene K Veldhuijzen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Amena A Ahmad
- Department of Health Sciences, Hamburg University of Applied Sciences, Faculty Life Sciences/Public Health Research, Hamburg, Germany
| | - Miriam Levi
- Department of Health Sciences, Division of Hygiene, Preventive Medicine and Public Health, University of Florence, Florence, Italy
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
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21
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Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect 2017; 145:2873-2885. [PMID: 28891457 PMCID: PMC5647665 DOI: 10.1017/s0950268817001947] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This systematic review aimed at estimating chronic hepatitis B (HBV) and C virus (HCV) prevalence in the European Union (EU) and Economic Area (EEA) countries in the general population, blood donors and pregnant women. We searched PubMed©, Embase© and Cochrane Library databases for reports on HBV and HCV prevalence in the general population and pregnant women in EU/EEA countries published between 2005 and 2015. Council of Europe data were used for HBV and HCV blood donor prevalence. HBV general population estimates were available for 13 countries, ranging from 0·1% to 4·4%. HCV general population estimates were available for 13 countries, ranging from 0·1% to 5·9%. Based on general population and blood donor estimates, the overall HBV prevalence in the EU/EEA is estimated to be 0·9% (95% CI 0·7-1·2), corresponding to almost 4·7 million HBsAg-positive cases; and the overall HCV prevalence to be 1·1% (95% CI 0·9-1·4), equalling 5·6 million anti-HCV-positive cases. We found wide variation in HCV and HBV prevalence across EU/EEA countries for which estimates were available, as well as variability between groups often considered a proxy for the general population. Prevalence estimates are essential to inform policymaking and public health practice. Comparing to other regions globally, HBV and HCV prevalence in the EU/EEA is low.
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22
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Effectiveness and cost-effectiveness of nationwide campaigns for awareness and case finding of hepatitis C targeted at people who inject drugs and the general population in the Netherlands. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:117-125. [PMID: 28826994 DOI: 10.1016/j.drugpo.2017.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/05/2017] [Accepted: 07/21/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Hepatitis C virus infection (HCV) is a serious, but underdiagnosed disease that can generally be treated successfully. Therefore, a nationwide HCV awareness campaign was implemented in the Netherlands targeting people who inject drugs (PWID) in addiction care ('PWID intervention') and high-risk groups in the general population ('public intervention'). The objective of this study is to assess the effectiveness and cost-effectiveness of the interventions used in this campaign. METHODS For the 'PWID' intervention, all addiction care centres in the Netherlands provided proactive individual HCV consultation and testing. The 'public intervention' consisted of health education through mass media and instruction of health care professionals. A Markov chain model was used to estimate incremental cost-effectiveness ratios (ICER, cost per QALY gained). We included a 'DAA treatment' scenario to estimate the effect of these treatment strategies on cost-effectiveness. RESULTS The 'PWID intervention' identified 257 additional HCV-carriers. The ICER was €9056 (95% CI: €6043-€13,523) when compared to 'no intervention'. The 'public intervention' identified 38 additional HCV-carriers. The ICER was €18,421 (95% CI: €7376-€25,490,119) when compared to 'no intervention'. Probabilistic sensitivity analysis showed that the probability that the 'PWID intervention' was cost-effective was 100%. It also showed a probability of 34% that the 'public intervention' did not exceed the Dutch threshold for cost-effectiveness (€20,000). New treatment regimens are likely to improve cost-effectiveness of this strategy. CONCLUSION In a nationwide HCV awareness and case finding campaign, the intervention targeting PWID was effective and cost-effective. An intervention targeting risk groups in the general population showed only a modest effect and is therefore less likely to be cost-effective.
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23
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Hussein NR, Balatay AA, Sezgin AT, Jawad RS. The distribution of HCV in subjects attending hospitals in Duhok City, Iraq. Asian Pac J Trop Biomed 2017. [DOI: 10.1016/j.apjtb.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Lazarus JV, Sperle I, Spina A, Rockstroh JK. Are the testing needs of key European populations affected by hepatitis B and hepatitis C being addressed? A scoping review of testing studies in Europe. Croat Med J 2017; 57:442-456. [PMID: 27815935 PMCID: PMC5141462 DOI: 10.3325/cmj.2016.57.442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aim To investigate whether or not key populations affected by hepatitis B and hepatitis C are being tested sufficiently for these diseases throughout the European region. Methods We searched MEDLINE and EMBASE for studies on HBV and HCV testing in the 53 Member States of the World Health Organization European Region following PRISMA criteria. Results 136 English-language studies from 24 countries published between January 2007 and June 2013 were found. Most studies took place in 6 countries: France, Germany, Italy, the Netherlands, Turkey, and the United Kingdom. 37 studies (27%) addressed HBV, 46 (34%) HCV, and 53 (39%) both diseases. The largest categories of study populations were people who use drugs (18%) and health care patient populations (17%). Far fewer studies focused on migrants, prison inmates, or men who have sex with men. Conclusions The overall evidence base on HBV and HCV testing has considerable gaps in terms of the countries and populations represented and validity of testing uptake data. More research is needed throughout Europe to guide efforts to provide testing to certain key populations.
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Affiliation(s)
- Jeffrey V Lazarus
- Jeffrey V Lazarus, CHIP, Rigshospitalet, University of Copenhagen, Oster Allé 56, 5th floor, DK-2100 Copenhagen O, Denmark,
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25
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Taaffe J, Wilson D. Mobilising a global response to hepatitis: Lessons learned from the HIV movement. Glob Public Health 2016; 13:473-488. [PMID: 27748158 DOI: 10.1080/17441692.2016.1233989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis caused by hepatitis B and C virus is increasingly becoming a significant global health threat, with widespread prevalence that may have severe disease and economic impacts in the future. Yet, preventative measures are not implemented universally and high costs of medicines limits treatment efforts. The global response to HIV/AIDS faced similar issues, but overcame them through a global movement that brought attention to the crisis and ultimately resulted in the creation and implementation of and access to better tools for HIV prevention and treatment. This also included effective policies and programmes behind and supporting the movement. Such could be done for hepatitis, specifically using lessons from the HIV response. Here, we will discuss the current and potentially severe future burden of hepatitis globally, the challenges in addressing this epidemic, and how principles applied from the global HIV response can facilitate a successful and similar hepatitis movement.
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26
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Roberts K, Macleod J, Metcalfe C, Simon J, Horwood J, Hollingworth W, Marlowe S, Gordon FH, Muir P, Coleman B, Vickerman P, Harrison GI, Waldron CA, Irving W, Hickman M. Hepatitis C - Assessment to Treatment Trial (HepCATT) in primary care: study protocol for a cluster randomised controlled trial. Trials 2016; 17:366. [PMID: 27473371 PMCID: PMC4966763 DOI: 10.1186/s13063-016-1501-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 07/13/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Public Health England (PHE) estimates that there are upwards of 160,000 individuals in England and Wales with chronic hepatitis C virus (HCV) infection, but until now only around 100,000 laboratory diagnoses have been reported to PHE and of these 28,000 have been treated. Targeted case-finding in primary care is estimated to be cost-effective; however, there has been no robust randomised controlled trial evidence available of specific interventions. Therefore, this study aims to develop and conduct a complex intervention within primary care and to evaluate this approach using a cluster randomised controlled trial. METHODS/DESIGN A total of 46 general practices in South West England will be randomised in a 1:1 ratio to receive either a complex intervention comprising: educational training on HCV for the practice; poster and leaflet display in the practice waiting rooms to raise awareness and encourage opportunistic testing; a HCV risk prediction algorithm based on information on possible risk markers in the electronic patient record run using Audit + software (BMJ Informatica). The audit will then be used to recall and offer patients a HCV test. Control practices will follow usual care. The effectiveness of the intervention will be measured by comparing number and rates of HCV testing, the number and proportion of patients testing positive, onward referral, rates of specialist assessment and treatment in control and intervention practices. Intervention costs and health service utilisation will be recorded to estimate the NHS cost per new HCV diagnosis and new HCV patient initiating treatment. Longer-term cost-effectiveness of the intervention in improving quality-adjusted life years (QALYs) will be extrapolated using a pre-existing dynamic health economic model. Patients' and health care workers' experiences and acceptability of the intervention will be explored through semi-structured qualitative interviews. DISCUSSION This trial has the potential to make an important impact on patient care and will provide high-quality evidence to help general practitioners make important decisions on HCV testing and onward referral. If found to be effective and cost-effective the intervention is readily scalable and can be used to support the implementation of NICE recommendations on HCV case-finding. TRIAL REGISTRATION ISRCTN61788850 . Registered on 24 April 2015; Protocol Version: 2.0, 22 May 2015.
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Affiliation(s)
- Kirsty Roberts
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration, 39 Whatley Road, Bristol, UK
| | - Joanne Simon
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration, 39 Whatley Road, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration, 39 Whatley Road, Bristol, UK
| | | | - Sharon Marlowe
- University Hospitals Bristol, Bristol Royal Infirmary, Marlborough Street, Bristol, UK
| | - Fiona H Gordon
- University Hospitals Bristol, Bristol Royal Infirmary, Marlborough Street, Bristol, UK
| | - Peter Muir
- Public Health Laboratory Bristol, Public Health England, Myrtle Road, Bristol, UK
| | - Barbara Coleman
- Public Health Commissioning and Performance, Avonquay, Merchants Road, Cumberland Basin, Bristol, UK
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Graham I Harrison
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, University Hospital Nottingham, Nottingham, UK
| | - Cherry-Ann Waldron
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - William Irving
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, University Hospital Nottingham, Nottingham, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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27
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Maan R, Toes-Zoutendijk E, Veldt BJ, Hansen BE, van der Meer AJ, de Knegt RJ. Epidemiological trends among the population with chronic HCV infection in the Netherlands. Antivir Ther 2015; 21:207-15. [PMID: 26436201 DOI: 10.3851/imp2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND As the field of antiviral therapy for chronic HCV infection is rapidly evolving, this study aimed to assess the epidemiological changes in patient and disease characteristics among individuals with chronic HCV infection. METHODS This study included all consecutive patients with chronic HCV monoinfection who were referred between 1990 and 2013 to the Erasmus MC University Medical Center Rotterdam, a large tertiary centre in the Netherlands. To identify trends over time, the study population was divided into six equal eras based on date of first visit to the outpatient clinic. RESULTS A total of 1,779 patients were diagnosed with chronic HCV infection. Mean age increased over time from 43.6 (sd 13.8) years to 51.7 (sd 11.2) years (P<0.001). The number of patients who were referred with cirrhosis increased over time, from 31 (25%) patients in Era 1 to 118 (42%) patients in Era 6 (P<0.001), respectively. More patients were referred with HCV genotype 1a and 3 in the last era, with 27 (48.2%) and 15 (14.0%) patients in Era 1 and 58 (54.2%) and 60 (21.8%) patients in Era 6 (P<0.001 both), respectively. The vast majority of patients (69.5%) were born between 1950 to 1975, with 62.5% of the patients being born between 1945 and 1965. CONCLUSIONS The HCV-infected population is ageing and is more often referred with severe liver disease. This study stresses the importance of urgently implementing national HCV screening programmes in order to be able to decrease the future burden of chronic HCV infection in the Netherlands.
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Affiliation(s)
- Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
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28
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The Spatial Distribution of Hepatitis C Virus Infections and Associated Determinants--An Application of a Geographically Weighted Poisson Regression for Evidence-Based Screening Interventions in Hotspots. PLoS One 2015; 10:e0135656. [PMID: 26352611 PMCID: PMC4564162 DOI: 10.1371/journal.pone.0135656] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/23/2015] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis C Virus (HCV) infections are a major cause for liver diseases. A large proportion of these infections remain hidden to care due to its mostly asymptomatic nature. Population-based screening and screening targeted on behavioural risk groups had not proven to be effective in revealing these hidden infections. Therefore, more practically applicable approaches to target screenings are necessary. Geographic Information Systems (GIS) and spatial epidemiological methods may provide a more feasible basis for screening interventions through the identification of hotspots as well as demographic and socio-economic determinants. Methods Analysed data included all HCV tests (n = 23,800) performed in the southern area of the Netherlands between 2002–2008. HCV positivity was defined as a positive immunoblot or polymerase chain reaction test. Population data were matched to the geocoded HCV test data. The spatial scan statistic was applied to detect areas with elevated HCV risk. We applied global regression models to determine associations between population-based determinants and HCV risk. Geographically weighted Poisson regression models were then constructed to determine local differences of the association between HCV risk and population-based determinants. Results HCV prevalence varied geographically and clustered in urban areas. The main population at risk were middle-aged males, non-western immigrants and divorced persons. Socio-economic determinants consisted of one-person households, persons with low income and mean property value. However, the association between HCV risk and demographic as well as socio-economic determinants displayed strong regional and intra-urban differences. Discussion The detection of local hotspots in our study may serve as a basis for prioritization of areas for future targeted interventions. Demographic and socio-economic determinants associated with HCV risk show regional differences underlining that a one-size-fits-all approach even within small geographic areas may not be appropriate. Future screening interventions need to consider the spatially varying association between HCV risk and associated demographic and socio-economic determinants.
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29
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Sharma S, Carballo M, Feld JJ, Janssen HLA. Immigration and viral hepatitis. J Hepatol 2015; 63:515-22. [PMID: 25962882 DOI: 10.1016/j.jhep.2015.04.026] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 01/09/2023]
Abstract
WHO estimates reveal that the global prevalence of viral hepatitis may be as high as 500 million, with an annual mortality rate of up to 1.3 million individuals. The majority of this global burden of disease is borne by nations of the developing world with high rates of vertical and iatrogenic transmission of HBV and HCV, as well as poor access to healthcare. In 2013, 3.2% of the global population (231 million individuals) migrated into a new host nation. Migrants predominantly originate from the developing countries of the south, into the developed economies of North America and Western Europe. This mass migration of individuals from areas of high-prevalence of viral hepatitis poses a unique challenge to the healthcare systems of the host nations. Due to a lack of universal standards for screening, vaccination and treatment of viral hepatitis, the burden of chronic liver disease and hepatocellular carcinoma continues to increase among migrant populations globally. Efforts to increase case identification and treatment among migrants have largely been limited to small outreach programs in urban centers, such that the majority of migrants with viral hepatitis continue to remain unaware of their infection. This review summarizes the data on prevalence of viral hepatitis and burden of chronic liver disease among migrants, current standards for screening and treatment of immigrants and refugees, and efforts to improve the identification and treatment of viral hepatitis among migrants.
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Affiliation(s)
- Suraj Sharma
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Manuel Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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30
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Hatzakis A, Chulanov V, Gadano AC, Bergin C, Ben-Ari Z, Mossong J, Schréter I, Baatarkhuu O, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Arkkila P, Barclay K, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Knegt RJ, de Vree M, Estes C, Flisiak R, Gane E, Gower E, Halota W, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Norris S, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Radke S, Rakhmanova A, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanchez Avila JF, Sanduijav R, Saraswat V, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Silva MO, Sokolov S, Sonderup M, Souliotis K, Spearman CW, Staub T, Stedman C, Strebkova EA, Struck D, Sypsa V, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuckerman E, Zuure FR, Puri P, Razavi H. The present and future disease burden of hepatitis C virus (HCV) infections with today's treatment paradigm - volume 2. J Viral Hepat 2015; 22 Suppl 1:26-45. [PMID: 25560840 DOI: 10.1111/jvh.12351] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Morbidity and mortality attributable to chronic hepatitis C virus (HCV) infection are increasing in many countries as the infected population ages. Models were developed for 15 countries to quantify and characterize the viremic population, as well as estimate the number of new infections and HCV related deaths from 2013 to 2030. Expert consensus was used to determine current treatment levels and outcomes in each country. In most countries, viremic prevalence has already peaked. In every country studied, prevalence begins to decline before 2030, when current treatment levels were held constant. In contrast, cases of advanced liver disease and liver related deaths will continue to increase through 2030 in most countries. The current treatment paradigm is inadequate if large reductions in HCV related morbidity and mortality are to be achieved.
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Affiliation(s)
- A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Saraswat V, Norris S, de Knegt RJ, Sanchez Avila JF, Sonderup M, Zuckerman E, Arkkila P, Stedman C, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Baatarkhuu O, Barclay K, Ben-Ari Z, Bergin C, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Chulanov V, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Vree M, Estes C, Flisiak R, Gadano AC, Gane E, Halota W, Hatzakis A, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Mossong J, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Puri P, Radke S, Rakhmanova A, Razavi H, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanduijav R, Schréter I, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Sokolov S, Souliotis K, Spearman CW, Staub T, Strebkova EA, Struck D, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuure FR, Silva MO, Sypsa V, Gower E. Historical epidemiology of hepatitis C virus (HCV) in select countries - volume 2. J Viral Hepat 2015; 22 Suppl 1:6-25. [PMID: 25560839 DOI: 10.1111/jvh.12350] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of liver related morbidity and mortality. In many countries, there is a lack of comprehensive epidemiological data that are crucial in implementing disease control measures as new treatment options become available. Published literature, unpublished data and expert consensus were used to determine key parameters, including prevalence, viremia, genotype and the number of patients diagnosed and treated. In this study of 15 countries, viremic prevalence ranged from 0.13% in the Netherlands to 2.91% in Russia. The largest viremic populations were in India (8 666 000 cases) and Russia (4 162 000 cases). In most countries, males had a higher rate of infections, likely due to higher rates of injection drug use (IDU). Estimates characterizing the infected population are critical to focus screening and treatment efforts as new therapeutic options become available.
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Affiliation(s)
- V Saraswat
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Zuure FR, Urbanus AT, Langendam MW, Helsper CW, van den Berg CHSB, Davidovich U, Prins M. Outcomes of hepatitis C screening programs targeted at risk groups hidden in the general population: a systematic review. BMC Public Health 2014; 14:66. [PMID: 24450797 PMCID: PMC4016146 DOI: 10.1186/1471-2458-14-66] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/10/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Effective screening programs are urgently needed to provide undiagnosed hepatitis C virus (HCV)-infected individuals with therapy. This systematic review of characteristics and outcomes of screening programs for HCV focuses on strategies to identify HCV risk groups hidden in the general population. METHODS We conducted a comprehensive search of MEDLINE and EMBASE databases for articles published between 1991-2010, including studies that screened the general population using either a newly developed (nonintegrated) screening program or one integrated in existing health care facilities. Look-back studies, prevalence studies, and programs targeting high-risk groups in care (e.g., current drug users) were excluded. RESULTS After reviewing 7052 studies, we identified 67 screening programs: 24 nonintegrated; 41 programs integrated in a variety of health care facilities (e.g., general practitioner); and 2 programs with both integrated and nonintegrated strategies. Together, these programs identified approximately 25,700 HCV-infected individuals. In general, higher HCV prevalence was found in programs in countries with intermediate to high HCV prevalence, in psychiatric clinics, and in programs that used a prescreening selection based on HCV risk factors. Only 6 programs used a comparison group for evaluation purposes, and 1 program used theory about effective promotion for screening. Comparison of the programs and their effectiveness was hampered by lack of reported data on program characteristics, clinical follow-up, and type of diagnostic test. CONCLUSIONS A prescreening selection based on risk factors can increase the efficiency of screening in low-prevalence populations, and we need programs with comparison groups to evaluate effectiveness. Also, program characteristics such as type of diagnostic test, screening uptake, and clinical outcomes should be reported systematically.
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Affiliation(s)
- Freke R Zuure
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
| | - Anouk T Urbanus
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
- Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (University of Amsterdam), P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Miranda W Langendam
- Dutch Cochrane Centre, Academic Medical Center, P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
| | - Charlotte HSB van den Berg
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
- Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (University of Amsterdam), P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Udi Davidovich
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
| | - Maria Prins
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
- Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (University of Amsterdam), P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
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Urbanus AT, van Keep M, Matser AA, Rozenbaum MH, Weegink CJ, van den Hoek A, Prins M, Postma MJ. Is adding HCV screening to the antenatal national screening program in Amsterdam, the Netherlands, cost-effective? PLoS One 2013; 8:e70319. [PMID: 23950920 PMCID: PMC3741285 DOI: 10.1371/journal.pone.0070319] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/17/2013] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection can lead to severe liver disease. Pregnant women are already routinely screened for several infectious diseases, but not yet for HCV infection. Here we examine whether adding HCV screening to routine screening is cost-effective. METHODS To estimate the cost-effectiveness of implementing HCV screening of all pregnant women and HCV screening of first-generation non-Western pregnant women as compared to no screening, we developed a Markov model. For the parameters of the model, we used prevalence data from pregnant women retrospectively tested for HCV in Amsterdam, the Netherlands, and from literature sources. In addition, we estimated the effect of possible treatment improvement in the future. RESULTS The incremental costs per woman screened was €41 and 0.0008 life-years were gained. The incremental cost-effectiveness ratio (ICER) was €52,473 which is above the cost-effectiveness threshold of €50,000. For screening first-generation non-Western migrants, the ICER was €47,113. Best-case analysis for both scenarios showed ICERs of respectively €19,505 and €17,533. We estimated that if costs per treatment were to decline to €3,750 (a reduction in price of €31,000), screening all pregnant women would be cost-effective. CONCLUSIONS Currently, adding HCV screening to the already existing screening program for pregnant women is not cost-effective for women in general. However, adding HCV screening for first-generation non-Western women shows a modest cost-effective outcome. Yet, best case analysis shows potentials for an ICER below €20,000 per life-year gained. Treatment options will improve further in the coming years, enhancing cost-effectiveness even more.
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Affiliation(s)
- Anouk T Urbanus
- Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands.
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Vermeiren APA, Dukers-Muijrers NHTM, van Loo IHM, Stals F, van Dam DW, Ambergen T, Hoebe CJPA. Identification of hidden key hepatitis C populations: an evaluation of screening practices using mixed epidemiological methods. PLoS One 2012; 7:e51194. [PMID: 23236452 PMCID: PMC3517446 DOI: 10.1371/journal.pone.0051194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/31/2012] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a major cause of liver diseases worldwide. Due to its asymptomatic nature, screening is necessary for identification. Because screening of the total population is not cost effective, it is important to identify which risk factors for positivity characterize the key populations in which targeting of screening yields the highest numbers of HCV positives, and assess which of these key populations have remained hidden to current care. METHODS Laboratory registry data (2002-2008) were retrieved for all HCV tests (23,800) in the south of the Netherlands (adult population 500,000). Screening trends were tested using Poisson regression and chi-square tests. Risk factors for HCV positivity were assessed using a logistic regression. The hidden HCV-positive population was estimated by a capture-recapture approach. RESULTS The number of tests increased over time (2,388 to 4,149, p<.01). Nevertheless, the positivity rate among those screened decreased between 2002 and 2008 (6.3% to 2.1%, p<.01). The population prevalence was estimated to be 0.49% (95%CI 0.41-0.59). Of all HCV-positive patients, 66% were hidden to current screening practices. Risk factors associated with positivity were low socio-economic status, male sex, and age between 36-55. In future screening 48% (95%CI 37-63) of total patients and 47% (95%CI 32-70) of hidden patients can be identified by targeting 9% (men with low socio-economic status, between 36-55 years old) of the total population. CONCLUSIONS Although the current HCV screening policy increasingly addresses high-risk populations, it only reaches one third of positive patients. This study shows that combining easily identifiable demographic risk factors can be used to identify key populations as a likely target for effective HCV screening. We recommend strengthening screening among middle-aged man, living in low socio-economic neighborhoods.
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Affiliation(s)
- Angelique P A Vermeiren
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, GGD Zuid Limburg, Geleen, The Netherlands.
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