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Li C, Zhang M, Karthijekan K, Fu X. How nurses contribute to the elimination of hepatitis B? A systematic review and meta-analysis. Int J Nurs Stud 2024; 149:104622. [PMID: 37944357 DOI: 10.1016/j.ijnurstu.2023.104622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND With approximately one-third of the global population exhibiting serological evidence of exposure, the hepatitis B virus remains a serious public health threat. Elimination of hepatitis B faces enormous challenges, from prevention to diagnosis, treatment, and long-term monitoring. Nurses are pivotal in optimising the hepatitis B care continuum; however, their contributions have been neglected. OBJECTIVE To identify the role of nurses in the elimination of hepatitis B and to synthesise the effectiveness of interventions with nursing roles in approaching the elimination target. DESIGN A systematic review and meta-analysis. SETTING(S) Thirteen databases (EMBASE, MEDLINE via OvidSP, Ovid Emcare, Ovid Nursing Database, British Nursing Index, APA PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Web of Science Core Collection, China National Knowledge Internet, SinoMed, and Wanfang Data) were searched from their inception to 6 December 2022. METHODS Interventional studies examining the contribution of nursing roles towards elimination targets were included. Content analysis was used to extract and map the nursing roles based on the nursing interventions classification system. Random-effects meta-analyses were conducted to examine the effectiveness of the intervention in improving hepatitis B screening, detection, and vaccination rates. RESULTS The synthesis from 16 studies identified 13 nursing roles that primarily involved (1) health education and counselling for informed patient decision-making regarding hepatitis B prevention, vaccination, screening, and disease monitoring; (2) case management and health promotion to advocate elimination services at multiple levels and enable equitable access among marginalised communities; and (3) running specialist clinics to lead advanced practices in prescribing and carrying diagnostic tests, formulating evidence-based individualised care plans, and coordinating care throughout the disease process. Interventions with these roles achieved pooled hepatitis B screening and detection rates of 64 % (95 % confidence interval [CI] = 0.44, 0.84) and 2 % (95 % CI = 0.00, 0.05), respectively, increased the odds of hepatitis B virus vaccination by 2.61 times (95 % CI = 1.60, 4.28), improved immunity rate, and enhanced patient adherence to antiviral treatment and monitoring of liver comorbidities. However, their effects on hepatitis B virus DNA-negative conversion rates and hepatocellular carcinoma incidence were not significant. CONCLUSIONS Nurses play multifaceted roles in advocating hepatitis B screening and vaccination, initiating outreach efforts in marginalised communities, and leading advanced practices that effectively contribute to the elimination of hepatitis B. Policymakers should consider how nurses may help the achievement of the elimination target. REGISTRATION PROSPERO (CRD42022380719) registered on December 12, 2022. TWEETABLE ABSTRACT Nurses raised awareness, initiated outreach efforts, addressed inequalities, and led advanced practices-effectively contributing to eliminating hepatitis B.
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Affiliation(s)
- Caixia Li
- Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong Province, China.
| | - Mengxing Zhang
- Department of Nursing, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
| | - Karthikesu Karthijekan
- Department of Supplementary Health Sciences, Faculty of Health-Care Sciences, Eastern University Sri Lanka, Vantharumoolai, Eastern Province, Sri Lanka.
| | - Xia Fu
- Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong Province, China.
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Hussain MRA, Ali M, Sugiyama A, Hiebert L, Rahman MA, Azam G, Ouoba S, E B, Ko K, Akita T, Ward JW, Tanaka J. The impact of COVID-19 on hepatitis B and C virus prevention, diagnosis, and treatment in Bangladesh compared with Japan and the global perspective. BMC Health Serv Res 2023; 23:1137. [PMID: 37872525 PMCID: PMC10594740 DOI: 10.1186/s12913-023-10138-x] [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: 04/28/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
AIM This study aimed to assess the effect of COVID-19 on hepatitis-related services in Bangladesh and compared the situation with same study conducted in Japan and globally. METHODS We conducted an online cross-sectional questionnaire survey among the clinicians of four societies associated with liver disease in Bangladesh from October to December 2022. The questionnaire included the same questions as a survey conducted in Japan and globally. RESULTS A total of 83 clinicians from 8 divisions in Bangladesh participated; 66.3% were heads of departments/institutions. Except for HCV treatment initiation, more than 30% of clinicians reported a 76-99% decline in all services. Compared to Japan and the global survey, there was a significantly higher decline in all HBV and HCV services in Bangladesh. To resume services back to pre-COVID-19 levels, Patient anxiety and fear (Bangladesh Survey: 80.7% vs Japan Survey: 67.4% vs Global Survey: 37.9%, p < 0.0001), loss of space due to COVID-19 (Bangladesh Survey: 63.9% vs Japan Survey: 34.7% vs Global Survey: 19.4%, p < 0.0001) were the main challenges. As part of the mitigation strategy, usage of telemedicine (Bangladesh Survey: 83.1% vs. Japan Survey: 67.3% vs Global Survey: 78.6% p < 0.0001), COVID-19 benefits, such as increased laboratory testing platforms (Bangladesh Survey: 77.1% vs Japan Survey: 17.9% vs Global Survey: 41.8%, p < 0.0001) was reported significantly higher in Bangladesh than in Japan and global survey. CONCLUSION All the services-related to HBV and HCV were highly affected during greatest impact month of COVID-19 in Bangladesh and the decline level was higher than Japan and global survey. Repeated countermeasures of COVID-19 and constrained healthcare-system were the probable reasons in Bangladesh. Positive impact resulting from COVID-19 countermeasures should be utilized in the national hepatitis program in Bangladesh.
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Affiliation(s)
- Md Razeen Ashraf Hussain
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan
| | - Mohammad Ali
- Department of Hepato-Biliary-Pancreatic Surgery & Liver Transplant, BIRDEM General Hospital, Dhaka, Bangladesh
- National Liver Foundation of Bangladesh, Dhaka, Bangladesh
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan
| | - Lindsey Hiebert
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
| | - M Anisur Rahman
- Department of Gastrointestinal Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, Bangladesh
| | - Golam Azam
- Department of Gastrointestinal Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, Bangladesh
| | - Serge Ouoba
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan
- Unité de Recherche Clinique de Nanoro (URCN), Institut de Recherche en Science de La Santé (IRSS), Nanoro, Burkina Faso
| | - Bunthen E
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan
- National Payment Certification, National Social Protection Council, Ministry of Economic and Finance, Phnom Penh, Cambodia
| | - Ko Ko
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima-Shi, 734-8551, Japan.
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Wang X, Du Z, Wang Y, Wang J, Huang S, Wang Y, Gu J, Deng W, Gilmour S, Li J, Hao Y. Impact and Cost-Effectiveness of Biomedical Interventions on Adult Hepatitis B Elimination in China: A Mathematical Modelling Study. J Epidemiol Glob Health 2023; 13:517-527. [PMID: 37349664 PMCID: PMC10469118 DOI: 10.1007/s44197-023-00132-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND China has one of the highest hepatitis B virus (HBV) disease burdens worldwide and tracking progress toward the 2030 HBV elimination targets is essential. This study aimed to assess the impact of biomedical interventions (i.e., adult vaccination, screening and treatment) on the adult HBV epidemic, estimate the time for HBV elimination, and evaluate the cost-effectiveness of the interventions in China. METHODS A deterministic compartmental model was developed to project the HBV epidemic from 2022 to 2050 and estimate the time to meet elimination targets under four intervention scenarios. Cost-effectiveness was calculated using incremental cost per quality-adjusted life year (QALY) gained, i.e., average cost-effectiveness ratio (CER). RESULTS Under the status quo, there will be 42.09-45.42 million adults living with HBV in 2050 and 11.04-14.36 million HBV-related deaths cumulatively from 2022 to 2050. Universal vaccination would cumulatively avert 3.44-3.95 million new cases at a cost of US$1027-1261/QALY gained. The comprehensive strategy would cumulatively avert 4.67-5.24 million new chronic cases and 1.39-1.85 million deaths, expediting the realization of the elimination targets forward to 2049. This strategy was also cost-effective with an average CER of US$20,796-26,685/QALY and a saved healthcare cost of US$16.10-26.84 per person. CONCLUSION China is not on track to meet the elimination targets but comprehensive biomedical interventions can accelerate the realization of the targets. A comprehensive strategy is cost-effective and cost-saving, which should be promoted in primary care infrastructures. Universal adult vaccination may be appropriate in the near future considering practical feasibility.
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Affiliation(s)
- Xinran Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yijing Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Junren Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shanshan Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ying Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China
- Guangzhou Joint Research Center for Disease Surveillance, Early Warning and Risk Assessment, Guangzhou, 510080, China
| | - Wanyu Deng
- College of Life Science, Shangrao Normal University, Shangrao, 334001, China
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 510080, China.
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, 510080, China.
- Guangzhou Joint Research Center for Disease Surveillance, Early Warning and Risk Assessment, Guangzhou, 510080, China.
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, 100191, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
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Soriano V, de Mendoza C, Treviño A, Ramos-Rincón JM, Moreno-Torres V, Corral O, Barreiro P. Treatment of hepatitis delta and HIV infection. Liver Int 2023; 43 Suppl 1:108-115. [PMID: 35748639 DOI: 10.1111/liv.15345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/20/2022] [Indexed: 01/18/2023]
Abstract
Hepatitis delta virus (HDV) is a defective agent that only infects individuals with hepatitis B virus (HBV). Around 5-10% of chronic hepatitis B patients worldwide are superinfected with HDV, which means 15-25 million people. Hepatitis delta is the most severe of all chronic viral hepatitis, leading to cirrhosis, liver cancer and/or transplantation in most patients. Despite it, many HDV patients remain undiagnosed. The only treatment available until recently was peginterferon alfa, with poor results and significant side effects. The recent approval of bulevirtide, a lipopeptide that blocks HBV/HDV entry, has revolutionized the field. Another drug, lonafarnib, already approved to treat progeria, is expected to be available soon as HDV therapy. Since there is no cell reservoir for the HDV RNA genome, hypothetically viral clearance could be achieved if complete blocking of viral replication occurs for a minimum time frame. This is what happens in hepatitis C using direct-acting antivirals, with the achievement of cure in nearly all treated patients. We envision the cure of hepatitis delta using combination antiviral therapy. Given that sexual and parenteral transmission routes are the most frequent for the acquisition of HBV and HDV, shared with HIV infection and HBV/HDV and HIV coinfection. The clinical outcome of hepatitis delta is worst in the HIV setting, with more frequent liver complications. Since most persons infected with HIV are on regular health care follow-up, we propose that HIV-HDV patients should be prioritized for moving forward new and potentially curative treatments for hepatitis delta.
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Affiliation(s)
| | - Carmen de Mendoza
- Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Madrid, Spain
| | - Ana Treviño
- UNIR Health Sciences School & Medical Center, Madrid, Spain
| | - José Manuel Ramos-Rincón
- Medicine Department, Alicante University Hospital & Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Víctor Moreno-Torres
- Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Madrid, Spain
| | - Octavio Corral
- UNIR Health Sciences School & Medical Center, Madrid, Spain
| | - Pablo Barreiro
- Public Health Regional Laboratory, Hospital Isabel Zendal, Madrid, Spain
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Xie J, Wang X, Pan D, Liu J, Li J, Gu J. Ageing and non-liver comorbidities in population with chronic hepatitis B infection in the western pacific region from 1990 to 2019. Front Physiol 2023; 14:1176113. [PMID: 37275222 PMCID: PMC10232771 DOI: 10.3389/fphys.2023.1176113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
Objectives: This study examined the age structure and burden of non-liver noncommunicable diseases in population with chronic hepatitis B virus (HBV) infection in the Western Pacific Region (WPR) from 1990 to 2019. Methods: We estimated ageing trends and the prevalence of non-liver NCDs among the HBV-infected population and the general population in 31 countries/areas in the Western Pacific Region from 1990 to 2019 based on the Global Burden of Disease 2019 dataset. Results: The proportion of individuals aged 60 or older among the HBV-infected population has increased at a faster rate compared to the general population, whereas the proportion of individuals younger than 19 years has decreased rapidly over the past three decades. Among the HBV-infected population, the prevalence of most (29/31) NCDs increased from 1990 to 2019, with the top three most significant increases found for non-Hodgkin's lymphoma (789.94% increase), prostate cancer (512.40% increase), and kidney cancer (411.34% increase). The prevalence of NCDs among the HBV-infected population increased faster than in the general population over the past three decades, especially in countries with rapid population ageing. Conclusion: This study highlights the increasing burden of non-liver comorbidities among the HBV-infected population. The integrated management of non-liver NCDs among this population should be implemented.
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Affiliation(s)
- Jinzhao Xie
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xu Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Deng Pan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiaye Liu
- School of Public Health, Shenzhen University Medical School, Shenzhen, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Health Informatics of Guangdong Province, Sun Yat-sen University, Guangzhou, China
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Wedemeyer H, Tergast TL, Lazarus JV, Razavi H, Bakoyannis K, Baptista-Leite R, Bartoli M, Bruggmann P, Buşoi CS, Buti M, Carballo M, Castera L, Colombo M, Coutinho RS, Dadon Y, Esmat G, Esteban R, Farran JC, Gillyon-Powell M, Goldberg D, Hutchinson S, Janssen HLA, Kalamitsis G, Kondili LA, Lambert JS, Marinho RT, Maticic M, Patricello A, Peck-Radosavljevic M, Pol S, Poljak M, Pop C, Sokol T, Sypsa V, Tözün N, Younossi Z, Aghemo A, Papatheodoridis GV, Hatzakis A. Securing wider EU commitment to the elimination of hepatitis C virus. Liver Int 2023; 43:276-291. [PMID: 36196744 DOI: 10.1111/liv.15446] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/04/2022] [Accepted: 09/29/2022] [Indexed: 01/25/2023]
Abstract
In 2016, the Hepatitis B and C Public Policy Association (HepBCPPA), gathered all the main stakeholders in the field of hepatitis C virus (HCV) to launch the now landmark HCV Elimination Manifesto, calling for the elimination of HCV in the EU by 2030. Since then, many European countries have made progress towards HCV elimination. Multiple programmes-from the municipality level to the EU level-were launched, resulting in an overall decrease in viremic HCV infections and liver-related mortality. However, as of 2021, most countries are not on track to reach the 2030 HCV elimination targets set by the WHO. Moreover, the COVID-19 pandemic has resulted in a decrease in HCV diagnoses and fewer direct-acting antiviral treatment initiations in 2020. Diagnostic and therapeutic tools to easily diagnose and treat chronic HCV infection are now well established. Treating all patients with chronic HCV infection is more cost-saving than treating and caring for patients with liver-related complications, decompensated cirrhosis or hepatocellular carcinoma. It is more important than ever to reinforce and scale-up action towards HCV elimination. Yet, efforts urgently need the dedicated commitment of policymakers at all governmental and policy levels. Therefore, the third EU Policy Summit, held in March 2021, featured EU parliamentarians and other key decision makers to promote dialogue and take strides towards securing wider EU commitment to advance and achieve HCV elimination by 2030. We have summarized the key action points and reported the 'Call-to-Action' statement supported by all the major relevant European associations in the field.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Tammo L Tergast
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, Colorado, USA
| | | | - Ricardo Baptista-Leite
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Institute of Health Sciences, Católica University of Portugal, Lisbon, Portugal
| | | | | | | | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron and CIBERHED del Instituto Carlos III, Barcelona, Spain
| | - Manuel Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon AP-HP-University of Paris-VII, Clichy, France
| | | | | | | | - Gamal Esmat
- Endemic Medicine and Department of HepatoGastroenterology Faculty of Medicine, Cairo University Hospital, Cairo, Egypt
| | - Rafael Esteban
- Liver Unit, Hospital Universitari Vall d'Hebron and CIBERHED del Instituto Carlos III, Barcelona, Spain
| | | | | | | | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | | | - John S Lambert
- Mater Misericordiae University Hospital, and UCD School of Medicine, Dublin, Ireland
| | - Rui Tato Marinho
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Markus Peck-Radosavljevic
- Department of Internal Medicine and Gastroenterology (IMuG) Hepatology, Endocrinology, Rheumatology and Nephrology with Centralized Emergency Department (ZAE), Klagenfurt, Austria
| | - Stanislas Pol
- Department of Hepatology, Université de Paris, APHP, Hopital Cochin, Paris, France
| | - Mario Poljak
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Cora Pop
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Vana Sypsa
- Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nurdan Tözün
- Department of Gastroenterology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Zobair Younossi
- Department of Medicine, Inova Health Fairfax Medical Campus, Fairfax, Virginia, USA
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Clinical and Research Hospital, Milan, Italy
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Clinical and economic value of sofosbuvir-based regimens in the treatment of chronic hepatitis C in Spain. PLoS One 2022; 17:e0278544. [PMID: 36454996 PMCID: PMC9714855 DOI: 10.1371/journal.pone.0278544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The treatment of chronic hepatitis C virus (HCV) with direct-acting antivirals has undergone a spectacular revolution and added significant value to healthcare systems and patients. The aim of the study was to evaluate the efficiency and value of Sofosbuvir (SOF)-based regimens for a target population of 85,959 chronic HCV patients treated in Spain during 2015-2019, compared to previous therapeutic strategies (peginterferon/ and ribavirin in double/triple therapy with telaprevir or boceprevir). METHODS A previously developed lifetime Markov model was adapted to simulate the disease HCV evolution. In SOF-based regimens, all patients (100%) were treated regardless with sustained virological response (SVR) of 93-98%, obtained from real-world data. In previous therapeutic, only ≥F2 patients were treated according to clinical practice (38%) with an average SVR of 61% taken from published literature. The value was measured as clinical and economic impact in terms of avoided HCV-related mortality and liver complications; total costs and quality-adjusted life years (QALYs) applying an annual 3% discount rate. RESULTS Compared to previous therapeutic, during lifetime, SOF-based regimens reduced decompensated cirrhosis by 89%, hepatocellular carcinoma by 77% and liver transplant by 84%, decreasing the cost associated to liver complications management in €770 million. SOF-based regimens also decreased liver-related mortality by 82%. Besides, SOF-based regimens gained 310,765/QALYs, saving €274 million (considering drugs, monitoring, and HCV management). CONCLUSION For Spain, SOF-based regimens offer value for HCV patients in terms of lowering HCV-related liver disease burden and generating significant cost savings for the health system, contributing to the WHO goal.
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Asynchronous electronic consultation between primary care and specialized care proved effective for continuum of care for viraemic hepatitis C patients. GASTROENTEROLOGÍA Y HEPATOLOGÍA 2022; 46:266-273. [PMID: 35964811 DOI: 10.1016/j.gastrohep.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION It has been proposed that primary care diagnose and treat hepatitis C virus (HCV) infection. However, a care circuit between primary and specialized care based on electronic consultation (EC) can be just as efficient in the micro-elimination of HCV. It is proposed to study characteristics and predictive factors of continuity of care in a circuit between primary and specialized care. METHODS From February/2018 to December/2019, all EC between primary and specialized care were evaluated and those due to HCV were identified. Variables for regression analysis and to identify predictors of completing the care cascade were recorded. RESULTS From 8098 EC, 138 were performed by 89 (29%) general practitioners over 118 patients (median 50.8 years; 74.6% men) and were related to HCV (1.9%). Ninety-two patients (78%) were diagnosed>6 months ago, and 26.3% met criteria for late presentation. Overall, 105 patients required assessment by the hepatologist, 82% (n=86) presented for the appointment, of which 67.6% (n=71) were viraemic, 98.6% of known. Finally, 61.9% (n=65) started treatment. Late-presenting status was identified as an independent predictor to complete the care cascade (OR 1.93, CI 1.71-1.99, p<0.001). CONCLUSION Communication pathway between Primary and Specialized Care based on EC is effective in avoiding significant losses of viraemic patients. However, the referral rate is very low, high in late-stage diagnoses, heterogeneous, and low in new diagnoses. Therefore, early detection strategies for HCV infection in primary care are urgently needed.
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Ashraf HUSSAIN MR, HIEBERT L, SUGIYAMA A, OUOBA S, E B, KO K, AKITA T, KANEKO S, KANTO T, WARD JW, TANAKA J. Effect of COVID-19 on hepatitis B and C virus countermeasures: Hepatologist responses from nationwide survey in Japan. Hepatol Res 2022; 52:899-907. [PMID: 35861597 PMCID: PMC9349947 DOI: 10.1111/hepr.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 02/08/2023]
Abstract
AIM Achieving hepatitis B virus (HBV) and hepatitis C virus (HCV) elimination requires continuous and sustained high volumes of diagnosis and treatment, which have been affected by the ongoing COVID-19 pandemic. This study assessed the effects of COVID-19 on hepatitis-related services in Japan and compared Japan's situation with a global survey. METHODS We conducted an online cross-sectional questionnaire survey of hepatologists from the Japan Society of Hepatology from August to October 2021 by using the same questionnaire from which a survey was conducted globally to address the effects of COVID-19 on hepatitis-related services. Hepatologists responded based on own impressions of their affiliated institutions. RESULTS In total, 196 hepatologists participated from 35 prefectures including 49.5% in managerial positions. Approximately 40% survey participants reported a 1%-25% decline in HBV and HCV screening and confirmatory testing. In addition, 53.6% and 45.4% reported no decline in HBV and HCV treatment initiation, respectively. Comparing any level of decrease with the global survey, there was less of a decline observed in Japan for screening (HBV: 51% vs. 56.3%, HCV: 51% vs. 70.9%) and treatment initiation (HBV: 32.7% vs. 52.4%, HCV: 41.8% vs. 66%). However, patient anxiety/fear (67.4%) and loss of staff due to COVID-19 (49.0%) were reported as challenges for resuming services to pre-COVID-19 levels. CONCLUSION Although in Japan all-inclusive decline in HBV- and HCV-related services were lower than in other countries, a greater decline was observed in HBV and HCV screening and diagnosis than in treatment initiation. Prolonged anxiety/fear among patients, and loss of staff and facilities from the COVID-19 response activities must be addressed to achieve elimination of hepatitis by 2030.
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Affiliation(s)
- Md Razeen Ashraf HUSSAIN
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan
| | - Lindsey HIEBERT
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan,Coalition for Global Hepatitis EliminationThe Task Force for Global Health, United States of AmericaDecaturGeorgiaUS
| | - Aya SUGIYAMA
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan
| | - Serge OUOBA
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan,Unité de Recherche Clinique de Nanoro (URCN)Institut de Recherche en Science de la Santé (IRSS)NanoroBurkina FasoJapan
| | - Bunthen E
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan,Payment Certification AgencyMinistry of HealthCambodiaUS
| | - Ko KO
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan
| | - Tomoyuki AKITA
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan
| | - Shuichi KANEKO
- Department of GastroenterologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Tatsuya KANTO
- The Research Center for Hepatitis and ImmunologyNational Center for Global Health and MedicineIchikawaChibaJapan
| | - John W. WARD
- Coalition for Global Hepatitis EliminationThe Task Force for Global Health, United States of AmericaDecaturGeorgiaUS
| | - Junko TANAKA
- Department of EpidemiologyInfectious Disease Control and Prevention, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaHiroshimaJapan
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10
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Kondili LA, Buti M, Riveiro-Barciela M, Maticic M, Negro F, Berg T, Craxì A. Impact of the COVID-19 pandemic on hepatitis B and C elimination: an EASL survey. JHEP Rep 2022; 4:100531. [PMID: 35967191 PMCID: PMC9364666 DOI: 10.1016/j.jhepr.2022.100531] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 02/09/2023] Open
Abstract
Background & Aims The World Health Organization (WHO) HBV and HCV elimination targets, set in 2016 and based on projections to 2030, were unable to consider the impact of intervening factors. To evaluate the impact of the COVID-19 pandemic on viral hepatitis elimination programs, the European Association for the Study of the Liver (EASL) conducted a survey in liver centers worldwide in 2021. Methods A web-based questionnaire was distributed (May-July 2021) to all EASL members representing clinical units providing HBV and HCV hepatitis care. Results are expressed as absolute numbers and reduction rates for each care activity. Results Data were collected from 32 European and 12 non-European clinical centers. Between January 2019 (pre-pandemic) and December 2020 (during the pandemic), chronic HBV consultations decreased by 32% and 26%, new referrals by 38% and 39%, HBV testing rates by 39% and 21% (for HBsAg detection) and 30% and 22% (for HBV DNA detection), and new HBV treatments by 20% and 44% (p = 0.328) in European and non-European centers, respectively. With regard to HCV during the same time frame, the overall reductions were 39% and 50% for consultations, 49% and 49% for new referrals, 11% and 38% for HCV RNA detection, and 51% and 54% for new HCV antiviral treatments for European and non-European Centers, respectively (p = 0.071). Conclusions All steps in the viral hepatitis care cascade have been hampered by the COVID-19 pandemic, with a comparable impact across different centers. These data reaffirm the pandemic’s major effect on global viral hepatitis elimination programs and suggest that actions to achieve the WHO 2030 targets should be reconsidered and revised to account for each country's progress relative to pre-pandemic values. Lay summary The EASL multinational survey conclusively shows that viral hepatitis elimination programs, expected to provide control of hepatitis B and hepatitis C worldwide by 2030, have been held back by the COVID-19 pandemic in clinical centers from several European and non-European countries, with a comparable impact across centers. Limitations in the cascade of care for both HBV and HCV were linked to limited access to screening, consultations, specific testing, and actual treatment. As restrictions for COVID-19 begin to lift, efforts to diagnose and provide treatment for viral hepatitis should remain high on the list of priorities for public health officials to maintain the WHO elimination efforts. Measures that have been put in place to control the COVID-19 pandemic could be transferred to increasing the diagnosis and linkage to care of people with hepatitis. Viral hepatitis elimination programs have been hampered by the COVID-19 pandemic. A survey performed in several clinical centers shows the impact of COVID-19 on all steps of the viral hepatitis care cascade. Measures used to control COVID-19 could be used to increase the diagnosis and linkage to care of people living with hepatitis B and C.
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11
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Kamal E, Asem N, Hassany M, Elshishiney G, Abdel-Razek W, Said H, Abdel Hamid S, Essam T, Rehan A, Salah A, Saad T, Shawky N, Mostafa A, Omar Y, Ammar I, Saeed R, AbdAllah M, Jabbour J, Hashish A, Bastawy S, El Qareh N, Gamaleldin N, Kabil K, Doss W, El-Sayed MH, Zaid H. Nationwide hepatitis C virus screening and treatment of adolescents in Egyptian schools. Lancet Gastroenterol Hepatol 2022; 7:658-665. [PMID: 35489364 DOI: 10.1016/s2468-1253(21)00464-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023]
Abstract
Until 2018, Egypt had the highest prevalence of hepatitis C virus (HCV) infection globally, affecting approximately 7% of the population. Despite efforts in diagnosis and treatment since 2006, nearly 2 million individuals with chronic HCV infection had yet to be diagnosed as of early 2018. In December, 2018, a mass HCV screening campaign for adolescents aged 15-18 years was initiated. Among 3 024 325 adolescents screened, the HCV antibody seroprevalence was 11 477 (0·38%), of whom 8187 (78·7%) were HCV RNA-positive. Sustained virological response 12 weeks after completion of treatment (SVR12) was attained by 7327 (99·6%) adolescents with a fixed-dose combination of generic ledipasvir 90 mg plus sofosbuvir 400 mg. Although mass screening in this age group might not be regularly adopted by many health systems and its cost-effectiveness might be lower than the screening of adults and high-risk groups (eg, patients on haemodialysis, people who inject drugs), breaking the chain of transmission in younger populations should lead to a reduction in HCV incidence and complications, and hasten the elimination of the disease.
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Affiliation(s)
- Ehab Kamal
- Tropical Medicine Medical Research Division, National Research Center, Giza, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hassany
- Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
| | | | - Wael Abdel-Razek
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shibin El Kom, Egypt
| | - Heba Said
- Ministry of Health and Population, Cairo, Egypt
| | | | - Tamer Essam
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Ahmed Rehan
- Ministry of Health and Population, Cairo, Egypt
| | - Aysam Salah
- Ministry of Health and Population, Cairo, Egypt
| | - Tarek Saad
- Ministry of Health and Population, Cairo, Egypt
| | - Nasr Shawky
- Ministry of Health and Population, Cairo, Egypt
| | | | - Yasser Omar
- Department of Medicine, Ain Shams University, Cairo, Egpyt
| | - Islam Ammar
- Tropical Medicine Department, Al-Azhar University, Cairo, Egypt
| | - Ramy Saeed
- Ministry of Health and Population, Cairo, Egypt
| | - Mohamed AbdAllah
- Tropical Medicine Medical Research Division, National Research Center, Giza, Egypt
| | - Jean Jabbour
- World Health Organization Egypt Office, Cairo, Egypt
| | - Alaa Hashish
- World Health Organization Egypt Office, Cairo, Egypt
| | - Samah Bastawy
- World Health Organization Egypt Office, Cairo, Egypt
| | - Noha El Qareh
- World Health Organization Egypt Office, Cairo, Egypt
| | - Nahla Gamaleldin
- World Health Organization Egypt Office, Cairo, Egypt; Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Kabil
- The National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - Wahid Doss
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Hala Zaid
- Ministry of Health and Population, Cairo, Egypt
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12
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Pourkarim M, Nayebzadeh S, Alavian SM, Hataminasab SH. Digital Marketing: A Unique Multidisciplinary Approach towards the Elimination of Viral Hepatitis. Pathogens 2022; 11:pathogens11060626. [PMID: 35745480 PMCID: PMC9228079 DOI: 10.3390/pathogens11060626] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 12/16/2022] Open
Abstract
New technologies are supported by the global implementation of the internet. These improvements have deeply affected various disciplines of sciences and consequently changed services such as daily business, particularly health sectors. Innovative digital marketing strategies utilize the channels of social media and retrieved user data to analyze and improve relevant services. These multidisciplinary innovations can assist specialists, physicians and researchers in diagnostic, prophylaxis and treatment issues in the health sector. Accordingly, compared to recent decades, health decision makers are more accurate and trustful in defining new strategies. Interestingly, using social media and mobile health apps in current pandemics of SARS-CoV-2 could be an important instance of the key role of these platforms at the local and global level of health policies. These digital technologies provide platforms to connect public health sectors and health politicians for communicating and spreading relevant information. Adding influencers and campaigns to this toolbox strengthens the implementation of public health programs. In 2016, the WHO adopted a global program to eliminate viral hepatitis by 2030. Recent constructive measures that have been used in the battle against COVID-19 could be adopted for the elimination of viral hepatitis program. The presented evidence in our narrative review demonstrates that the application of digital marketing tools to create campaigns on social media, armed with professional influencers, can efficiently consolidate this program. The application of different strategies in using these popular tools will raise the public awareness about viral hepatitis. Subsequently, the availability of an effective vaccine for HBV and antiviral medication for HCV can motivate the audience to take steps towards prophylaxis and screening methods against these infectious illnesses. The encouragement of health policy makers to apply digital communication technologies and comprehensive roadmaps to implement this global program will certainly decrease the burden of viral hepatitis worldwide.
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Affiliation(s)
- Mohammadreza Pourkarim
- Department of Management, Yazd Branch, Islamic Azad University, Yazd P.O. Box 89195/155, Iran; (M.P.); (S.H.H.)
| | - Shahnaz Nayebzadeh
- Department of Management, Yazd Branch, Islamic Azad University, Yazd P.O. Box 89195/155, Iran; (M.P.); (S.H.H.)
- Correspondence: ; Tel.: +98-351-8211391; Fax: +98-351-8214810
| | | | - Seyyed Hassan Hataminasab
- Department of Management, Yazd Branch, Islamic Azad University, Yazd P.O. Box 89195/155, Iran; (M.P.); (S.H.H.)
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13
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Konopleva MV, Feldsherova AA, Elgort DA, Tupoleva TA, Kokhanovskaya NA, Pankratova VN, Semenenko TA, Suslov AP. [Identification by enzyme immunoassay of escape mutants S143L and G145R of hepatitis B virus ( Hepadnaviridae: Orthohepadnavirus: Hepatitis B virus)]. Vopr Virusol 2022; 67:48-58. [PMID: 35293188 DOI: 10.36233/0507-4088-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The achievement of the goal of the World Health Organization to eliminate viral hepatitis B by 2030 seems to be problematic partly due to the presence of escape mutants of its etiological agent, hepatitis B virus (HBV) (<i>Hepadnaviridae: Orthohepadnavirus: Hepatitis B virus</i>), that are spreading mainly in the risk groups. Specific routine diagnostic assays aimed at identification of HBV escape mutants do not exist.The study aimed the evaluation of the serological fingerprinting method adapted for routine detection of escape mutations in 143 and 145 aa positions of HBV surface antigen (HBsAg). MATERIAL AND METHODS HBV DNA from 56 samples of HBsAg-positive blood sera obtained from donors, chronic HBsAg carriers and oncohematology patients has been sequenced. After the identification of mutations in HBsAg, the samples were tested in the enzyme-linked immunosorbent assay (ELISA) kit «Hepastrip-mutant-3K». RESULTS AND DISCUSSION Escape mutations were detected mainly in patients with hematologic malignancies. Substitutions in 143 and 145 aa were found in 10.81% and in 8.11% of such patients, respectively. The G145R mutation was recognized using ELISA kit in almost all cases. The kit specifically recognized the S143L substitution in contrast to the S143T variant. The presence of neighbor mutation D144E can be assumed due to it special serological fingerprint. CONCLUSION ELISA-based detection of escape mutations S143L, D144E and G145R can be used for routine diagnostics, especially in the risk groups. The diagnostic parameters of the kit can be refined in additional studies. This immunoassay and methodology are applicable for the development and quality control of vaccines against escape mutants.
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Affiliation(s)
- M V Konopleva
- FSBI «National Research Centre for Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - A A Feldsherova
- FSBI «National Research Centre for Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - D A Elgort
- FSBI «National Research Centre for Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - T A Tupoleva
- FSBI «National Medical Research Center for Hematology» of the Ministry of Health of Russia
| | - N A Kokhanovskaya
- FSBI «National Research Centre for Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - V N Pankratova
- FSBI «National Research Centre for Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - T A Semenenko
- FSBI «National Research Centre for Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - A P Suslov
- FSBI «National Research Centre for Epidemiology and Microbiology named after honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
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14
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Razavi H. Polaris Observatory—supporting informed decision-making at the national, regional, and global levels to eliminate viral hepatitis. Antivir Ther 2022; 27:13596535221083179. [DOI: 10.1177/13596535221083179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Tools to eliminate Hepatitis B and C have been available and in 2016, the World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis. However, the adoption of hepatitis elimination programs has remained slow. Research design: The Center for Disease Analysis created a universal registry, the Polaris Observatory, to support informed decision-making at the national, regional, and global level for HCV and HBV elimination. The observatory covers 110 countries for HCV and 135 countries for HBV and provides decision analytics, disease burden modeling, economic impact assessments, and training to help countries with their national hepatitis elimination programs. Results: By providing reliable and up-to-date country specific data and analyses, demonstrating the impact of decisions, and providing costing estimates of national programs, our collaborating countries are making informed decisions. Our economic impact analyses also helped countries fund their elimination programs and negotiate prices. Polaris Observatory is an example of impactful private–public partnership where funding by the John C. Martin Foundation allowed support for informed decision-making by public agencies and national governments who would not/could not support such programs on their own. Conclusions: The catalytic funding allowed the Polaris Observatory to demonstrate the utility of such a program resulting in other donors to support this work. The Polaris Observatory is now supported through a portfolio of funders while our work and outputs remain independent to continue support for viral hepatitis elimination by year 2030.
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Affiliation(s)
- Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
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15
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Tanaka J, Kurisu A, Ohara M, Ouoba S, Ohisa M, Sugiyama A, Wang ML, Hiebert L, Kanto T, Akita T. Burden of chronic hepatitis B and C infections in 2015 and future trends in Japan: A simulation study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 22:100428. [PMID: 35637862 PMCID: PMC9142742 DOI: 10.1016/j.lanwpc.2022.100428] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Determining the number of chronic hepatitis B (HBV) and C virus (HCV) infections is essential to assess the progress towards the World Health Organization 2030 viral hepatitis elimination goals. Using data from the Japanese National Database (NDB), we calculated the number of chronic HBV and HCV infections in 2015 and predicted the trend until 2035. Methods NDB and first-time blood donors data were used to calculate the number of chronic HBV and HCV infections in 2015. A Markov simulation was applied to predict chronic infections until 2035 using transition probabilities calculated from NDB data. Findings The total number of chronic HBV and HCV infections in 2015 in Japan was 1,905,187–2,490,873 (HCV:877,841–1,302,179, HBV:1,027,346–1,188,694), of which 923,661–1,509,347 were undiagnosed or diagnosed but not linked to care (“not engaged in care”), and 981,526 were engaged in care. Chronic HBV and HCV infections are expected to be 923,313–1,304,598 in 2030, and 739,118–1,045,884 in 2035. Compared to 2015, by 2035, the number of persons with HCV not engaged in care will decline by 59·8 – 76·1% and 86·5% for patients in care. For HBV, a 47·3 – 49·3% decrease is expected for persons not engaged in care and a decline of 26·0% for patients engaged in care. Interpretation Although the burden of HBV and HCV is expected to decrease by 2035, challenges in controlling hepatitis remain. Improved and innovative screening strategies with linkage to care for HCV cases, and a functional cure for HBV are needed. Funding Japan Ministry of Health, Labour and Welfare.
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Affiliation(s)
- Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Project Research Center for Epidemiology and Prevention of Viral Hepatitis and Hepatocellular Carcinoma, Hiroshima University, Hiroshima, Japan
- Corresponding authors at: Department of Epidemiology, Infectious Disease Control and Prevention, Graduate school of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi 734-8551, Japan.
| | - Akemi Kurisu
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Project Research Center for Epidemiology and Prevention of Viral Hepatitis and Hepatocellular Carcinoma, Hiroshima University, Hiroshima, Japan
| | - Masatsugu Ohara
- Department of Gastroenterology and Hepatology, National Hospital Organization Hokkaido Medical Center, Hokkaido, Japan
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Serge Ouoba
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Unité de Recherche Clinique de Nanoro (URCN), Institut de Recherche en Science de la Santé (IRSS), Nanoro, Burkina Faso
| | - Masayuki Ohisa
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Project Research Center for Epidemiology and Prevention of Viral Hepatitis and Hepatocellular Carcinoma, Hiroshima University, Hiroshima, Japan
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Project Research Center for Epidemiology and Prevention of Viral Hepatitis and Hepatocellular Carcinoma, Hiroshima University, Hiroshima, Japan
| | - Michelle L. Wang
- Project Research Center for Epidemiology and Prevention of Viral Hepatitis and Hepatocellular Carcinoma, Hiroshima University, Hiroshima, Japan
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
| | - Lindsey Hiebert
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
| | - Tatsuya Kanto
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Project Research Center for Epidemiology and Prevention of Viral Hepatitis and Hepatocellular Carcinoma, Hiroshima University, Hiroshima, Japan
- Corresponding authors at: Department of Epidemiology, Infectious Disease Control and Prevention, Graduate school of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi 734-8551, Japan.
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16
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Global elimination of hepatitis C: a warning from the data. Lancet Gastroenterol Hepatol 2022; 7:380-381. [DOI: 10.1016/s2468-1253(22)00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/18/2022]
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17
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Sonderup MW, Spearman CW. Global Disparities in Hepatitis B Elimination-A Focus on Africa. Viruses 2022; 14:v14010082. [PMID: 35062286 PMCID: PMC8777803 DOI: 10.3390/v14010082] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 02/07/2023] Open
Abstract
In 2016, WHO member states at the World Health Assembly adopted a Global Health Sector Strategy that included a policy of eliminating viral hepatitis. Clear targets were established to assist in achieving this by 2030. The strategy, while achievable, has exposed existing global disparities in healthcare systems and their ability to implement such policies. Compounding this, the regions with most disparity are also those where the hepatitis B prevalence and disease burden are the greatest. Foundational to hepatitis B elimination is the identification of both those with chronic infection and crucially pregnant women, and primary prevention through vaccination. Vaccination, including the birth dose and full three-dose coverage, is key, but complete mother-to-child transmission prevention includes reducing the maternal hepatitis B viral load in the third trimester where appropriate. Innovations and simplified tools exist in order to achieve elimination, but what is desperately required is the will to implement these strategies through the support of appropriate investment and funding. Without this, disparities will continue.
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18
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Yonezawa A, Grant R, Shimakawa Y. Including the voice of people living with viral hepatitis: lessons learned from Japan to accelerate progress towards global hepatitis elimination. Trop Med Health 2021; 49:79. [PMID: 34598715 PMCID: PMC8485555 DOI: 10.1186/s41182-021-00371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Despite the growing momentum created by the WHO for eliminating viral hepatitis as a public health threat by 2030, the global response is still slow and more actions are needed to meet the elimination goals, especially in low-income and middle-income countries. Japan is one of a handful of countries currently on track to achieve the WHO hepatitis elimination targets by 2030. To better understand the successful control of viral hepatitis in Japan, it is important to recognize the role of the patient association for viral hepatitis, known as the “Japan Hepatitis Council”, which celebrates its 50th anniversary in 2021. The greatest impact of the Japan Hepatitis Council has been in achieving wider access to antiviral treatments for viral hepatitis. The example of Japan and the Japan Hepatitis Council highlights the need for the engagement of civil society and patient groups to ensure equitable access to hepatitis services and to accelerate the global hepatitis elimination.
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Affiliation(s)
- Atsuko Yonezawa
- Japan Hepatitis Council, 4-27-5-201 Shimo-ochiai, Shinjuku-ku, Tokyo, 161-0033, Japan.
| | - Rebecca Grant
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, 25-28 rue du Dr Roux, 75015, Paris, France.,Sorbonne Université, Paris, France
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, 25-28 rue du Dr Roux, 75015, Paris, France.
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19
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The Netherlands Is on Track to Meet the World Health Organization Hepatitis C Elimination Targets by 2030. J Clin Med 2021; 10:jcm10194562. [PMID: 34640576 PMCID: PMC8509638 DOI: 10.3390/jcm10194562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The Netherlands strives for hepatitis C virus (HCV) elimination, in accordance with the World Health Organization targets. An accurate estimate when HCV elimination will be reached is elusive. We have embarked on a nationwide HCV elimination project (CELINE) that allowed us to harvest detailed data on the Dutch HCV epidemic. This study aims to provide a well-supported timeline towards HCV elimination in The Netherlands. Methods: A previously published Markov model was used, adopting published data and unpublished CELINE project data. Two main scenarios were devised. In the Status Quo scenario, 2020 diagnosis and treatment levels remained constant in subsequent years. In the Gradual Decline scenario, an annual decrease of 10% in both diagnoses and treatments was implemented, starting in 2020. WHO incidence target was disregarded, due to low HCV incidence in The Netherlands (≤5 per 100,000). Results: Following the Status Quo and Gradual Decline scenarios, The Netherlands would meet WHO’s elimination targets by 2027 and 2032, respectively. From 2015 to 2030, liver-related mortality would be reduced by 97% in the Status Quo and 93% in the Gradual Decline scenario. Compared to the Status Quo scenario, the Gradual Decline scenario would result in 12 excess cases of decompensated cirrhosis, 18 excess cases of hepatocellular carcinoma, and 20 excess cases of liver-related death from 2020–2030. Conclusions: The Netherlands is on track to reach HCV elimination by 2030. However, it is vital that HCV elimination remains high on the agenda to ensure adequate numbers of patients are being diagnosed and treated.
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Abstract
Purpose of Review The purpose of our review was to summarize current recommendations on testing strategies, antiviral therapy eligibility and monitoring, and prevention of mother-to-child transmission of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and to highlight major research gaps in low and middle-income countries (LMIC), with a particular focus on sub-Saharan Africa (SSA). Recent Findings While data on the prevalence of HBV and HCV infections in LMIC are increasing, current knowledge on liver-related complications as well as on treatment outcomes remains limited. Furthermore, very little information is available on the feasibility and cost-effectiveness of large-scale testing and management strategies in high-prevalence settings. The availability of policy-relevant data is particularly scarce in SSA, which accounts for a significant part of the global burden of chronic viral hepatitis. Summary Current recommendations on the management and monitoring of chronic viral hepatitis rely mainly on data from high-income settings. The global elimination of viral hepatitis will only be achieved if prevention, testing, and treatment strategies tailored to specific LMIC are implemented. In order to inform scalable and cost-effective interventions, dedicated research initiatives have to be undertaken. Future studies will have to include the evaluation of innovative testing strategies, the validation of simplified methods to diagnose liver cirrhosis and hepatocellular carcinoma, and the monitoring of long-term treatment outcomes and toxicity. In addition, national plans to achieve the elimination of HBV mother-to-child transmission are urgently needed, including effective ways to test pregnant women, treat those who are eligible, and ensure birth dose vaccination is given to all newborns.
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Gountas I, Yiasemi I, Kyprianou E, Mina C, Georgiou C, Katsioloudes P, Kouroufexi A, Demetriou A, Xenofontos E, Nikolopoulos G. Planning the hepatitis C virus elimination in Cyprus: A modeling study. World J Gastroenterol 2021; 27:5219-5231. [PMID: 34497446 PMCID: PMC8384746 DOI: 10.3748/wjg.v27.i31.5219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/13/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major global public health problem. In the Republic of Cyprus, the estimated prevalence of chronic hepatitis C (CHC) among the general population is 0.6%, while the CHC prevalence among people who inject drugs (PWID) is estimated at 46%. Direct-acting antivirals that can eliminate HCV are not yet widely available in the Republic of Cyprus. However, when direct-acting antivirals become available, a long-term strategic plan to guide elimination efforts will be needed to maximize the effect of treatment.
AIM To determine the programmatic targets to eliminate HCV in the Republic of Cyprus.
METHODS A dynamic, stochastic, individual-based model of HCV transmission, disease progression, and cascade of care was calibrated to data from Cyprus. The model stratifies the population into the infected general population and the PWID population. A variety of test, prevention, and treatment strategies concerning the general population, PWID, or both were examined. The time horizon of the analysis was until 2034.
RESULTS Under the status quo scenario, the model predicted that 75 (95% confidence interval (CI): 60, 91) and 575 (95%CI: 535, 615) liver-related deaths and new infections would occur by 2034, respectively. Launching an expanded treatment program, without screening interventions, would cause modest outcomes regarding CHC prevalence (16.6% reduction in 2034 compared to 2020) and liver-related deaths (10 deaths would be prevented compared to the status quo scenario by 2034). Implementing a test and treat strategy among the general population but without any intervention in the PWID population would suffice to meet the mortality target but not the incidence target. To achieve HCV elimination in Cyprus, 3080 (95%CI: 3000, 3200) HCV patients need to be diagnosed and treated by 2034 (2680 from the general population and 400 from PWID), and harm reduction coverage among PWID should be increased by 3% per year (from 25% in 2020 to 67% in 2034).
CONCLUSION Elimination of HCV is a demanding public health strategy, which requires significant interventions both among the general population and high-risk groups.
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Affiliation(s)
- Ilias Gountas
- Medical School, University of Cyprus, Nicosia 1678, Cyprus
| | - Ioanna Yiasemi
- Cyprus Monitoring Centre, Cyprus National Addictions Authority, Nicosia 1678, Cyprus
| | - Evi Kyprianou
- Cyprus Monitoring Centre, Cyprus National Addictions Authority, Nicosia 1678, Cyprus
| | - Christos Mina
- Cyprus Monitoring Centre, Cyprus National Addictions Authority, Nicosia 1678, Cyprus
| | | | | | - Andri Kouroufexi
- Ministry of Health, Pharmaceutical Services, Nicosia 1678, Cyprus
| | - Anna Demetriou
- Ministry of Health, Health Monitoring Unit, Nicosia 1678, Cyprus
| | - Elena Xenofontos
- Department of Internal Medicine, Limassol General Hospital, Limassol 4131, Cyprus
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22
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Eleje GU, Akaba GO, Mbachu II, Rabiu A, Loto OM, Usman HA, Fiebai PO, Chukwuanukwu RC, Joe-Ikechebelu NN, Nwankwo CH, Kalu SO, Onubogu CU, Ogbuagu CN, Chukwurah SN, Uzochukwu CE, Inuyomi SO, Adesoji BA, Ogwaluonye UC, Nweje SI, Egeonu RO, Igue OE, Jibuaku CH, Aja PO, Chidozie CP, Ibrahim HS, Aliyu FE, Numan AI, Okoro OD, Omoruyi SA, Oppah IC, Anyang UI, Ahmed A, Umeononihu OS, Umeh EO, Emeka EA, Onwuegbuna AA, Igbodike EP, Ajuba IC, Yakasai IA, Ezechi OC, Ikechebelu JI. Pregnant women's hepatitis B vaccination coverage in Nigeria: a national pilot cross-sectional study. Ther Adv Vaccines Immunother 2021; 9:25151355211032595. [PMID: 34377929 PMCID: PMC8327013 DOI: 10.1177/25151355211032595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine the hepatitis B vaccination coverage, full-dose (⩾3) coverage and the associated factors affecting uptake among pregnant women. METHODS This was a cross-sectional study among pregnant women attending antenatal care in six tertiary hospitals across all the geopolitical zones of Nigeria. Pregnant women who consented to the study completed screening questions about their hepatitis B vaccination status and coverage. The main outcome measures were hepatitis B vaccination coverage rate, dose, and factors affecting uptake. Bivariate analysis was performed by the chi-square test and conditional logistic regression analysis was used to determine variables associated with uptake of the vaccination. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated and statistical significance was accepted when p-value was < 0.05. RESULTS Of 159 pregnant women who completed the interview questions, 21 [13.2%, 95% confidence interval (CI) 7.9-18.5%] were vaccinated for hepatitis B for one to three doses. The numbers of doses received were: three doses (8/159, 5.0%), two doses (5/159, 3.1%), and one dose (8/159, 5.0%). The reasons for non-uptake of vaccination included: lack of awareness of the vaccine 83/138 (60.1%), inadequate access to vaccine 11/138 (8.0%), and positivity to hepatitis B virus 10/138 (7.2%). The uptake of hepatitis B vaccination was significantly affected by the level of education (OR 0.284, 95% CI 0.08-1.01, p = 0.041), but in multivariable logistic regression, adjusted for confounders, the association between hepatitis B vaccination and participants' level of education (aOR 3.09; 95% CI 0.95-10.16; p = 0.061) did not remain significant. CONCLUSIONS In Nigeria, the national hepatitis B vaccination coverage among pregnant women appears poor, with the full-dose coverage even poorer. The level of education was not positively associated with uptake of hepatitis B vaccination, while lack of awareness of the vaccine was the commonest reason for non-uptake. FUNDING TETFund National Research Fund 2019 (grant number TETFund/DR&D/CE/NRF/STI/33).
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Affiliation(s)
- George Uchenna Eleje
- Effective Care Research Unit, Department of
Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University,
Awka, Nigeria
- Department of Obstetrics and Gynecology, Nnamdi
Azikiwe University Teaching Hospital, Number 49 Nnewi Onitsha Road, 435001,
Nnewi, Anambra State, Nigeria
| | - Godwin Otuodichinma Akaba
- Department of Obstetrics and Gynecology,
University of Abuja, Abuja, Nigeria
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ikechukwu Innocent Mbachu
- Department of Obstetrics and Gynecology, Nnamdi
Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology, Nnamdi
Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ayyuba Rabiu
- Department of Obstetrics and Gynecology, Bayero
University, Kano, Nigeria
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | - Olabisi Morebise Loto
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Hadiza Abdullahi Usman
- Department of Obstetrics and Gynecology,
University of Maiduguri, Maiduguri, Nigeria
- Department of Obstetrics and Gynecology,
University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Preye Owen Fiebai
- Department of Obstetrics and Gynecology,
University of Port Harcourt, Port Harcourt, Nigeria
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | | | - Ngozi Nneka Joe-Ikechebelu
- Department of Community Medicine, Chukwuemeka
Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | | | - Stephen Okoroafor Kalu
- HIV Care Laboratory/HIV Care Department,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | | | - Shirley Nneka Chukwurah
- Gastroenterology Unit, Department of Medicine,
Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | | | | | - Bukola Abimbola Adesoji
- Department of Nursing, Obafemi Awolowo
University Teaching Hospital Complex, Ile-Ife, Nigeria
| | | | | | - Richard Obinwanne Egeonu
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
| | - Odion Emmanuel Igue
- Department of Physiological Sciences, Obafemi
Awolowo University, Ile-Ife, Nigeria
| | | | - Prince Ogbonnia Aja
- Immunology Unit, Department of Medical
Laboratory Science, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Hadiza Sani Ibrahim
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | - Fatima Ele Aliyu
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | - Aisha Ismaila Numan
- Department of Obstetrics and Gynecology,
University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Ogbonna Dennis Okoro
- Department of Parasitology & Entomology,
Faculty of Veterinary Medicine, University of Maiduguri, Maiduguri, Borno
State, Nigeria
| | - Solace Amechi Omoruyi
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ijeoma Chioma Oppah
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ubong Inyang Anyang
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Aishat Ahmed
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Osita Samuel Umeononihu
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
| | - Eric Okechukwu Umeh
- Department of Radiology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekene Agatha Emeka
- Department of Family Medicine, Faculty of
Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Emeka Philip Igbodike
- Department of Obstetrics and Gynecology, St
Georges Hospital Memorial Centre, Lagos, Nigeria
| | - Ifeoma Clara Ajuba
- Department of Hematology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
| | - Ibrahim Adamu Yakasai
- Department of Obstetrics and Gynecology,
Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
| | | | - Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
| | - Triplex Infection in Pregnancy Collaboration Group
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Obstetrics and Gynecology,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State,
Nigeria
- Department of Obstetrics and Gynecology,
University of Abuja, Abuja, Nigeria
- Department of Obstetrics and Gynecology,
University of Abuja Teaching Hospital, Abuja, Nigeria
- Department of Obstetrics and Gynecology,
Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynecology, Aminu
Kano Teaching Hospital, Kano, Nigeria
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Obstetrics and Gynecology,
Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
- Department of Obstetrics and Gynecology,
University of Maiduguri, Maiduguri, Nigeria
- Department of Obstetrics and Gynecology,
University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
- Department of Obstetrics and Gynecology,
University of Port Harcourt, Port Harcourt, Nigeria
- Department of Obstetrics and Gynecology,
University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
- Immunology Unit, Department of Medical
Laboratory Science, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Community Medicine, Chukwuemeka
Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
- Department of Statistics, Nnamdi Azikiwe
University, Awka, Nigeria
- HIV Care Laboratory/HIV Care Department,
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Paediatrics, Nnamdi Azikiwe
University, Awka, Nigeria
- Department of Medical Microbiology and
Parasitology, Faculty of Medicine, Nnamdi Azikiwe University, Awka,
Nigeria
- Gastroenterology Unit, Department of Medicine,
Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Mass Communication, Nnamdi
Azikiwe University, Awka, Nigeria
- Department of Physics and Engineering Physics,
Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Nursing, Obafemi Awolowo
University Teaching Hospital Complex, Ile-Ife, Nigeria
- Department of Pharmaceutical Sciences, Nnamdi
Azikiwe University, Awka, Nigeria
- Department of Nursing, Nnamdi Azikiwe
University Teaching Hospital, Nnewi, Nigeria
- Department of Physiological Sciences, Obafemi
Awolowo University, Ile-Ife, Nigeria
- Department of Parasitology & Entomology,
Faculty of Veterinary Medicine, University of Maiduguri, Maiduguri, Borno
State, Nigeria
- Department of Radiology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
- Department of Family Medicine, Faculty of
Medicine, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Ophthalmology, Nnamdi Azikiwe
University, Awka, Nigeria
- Department of Obstetrics and Gynecology, St
Georges Hospital Memorial Centre, Lagos, Nigeria
- Department of Hematology, Faculty of Medicine,
Nnamdi Azikiwe University, Awka, Nigeria
- Nigerian Institute of Medical Research, Lagos,
Nigeria
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Mohamed R, Cordie A, Lazarus JV, Esmat G. Micro-elimination of hepatitis C among people living with HIV in Egypt. Liver Int 2021; 41:1445-1447. [PMID: 34139062 DOI: 10.1111/liv.14974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/13/2023]
Affiliation(s)
- Rahma Mohamed
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt.,Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed Cordie
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt.,Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo, Egypt
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gamal Esmat
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt
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Alqahtani SA, Broering DC, Alghamdi SA, Bzeizi KI, Alhusseini N, Alabbad SI, Albenmousa A, Alfaris N, Abaalkhail F, Al-Hamoudi WK. Changing trends in liver transplantation indications in Saudi Arabia: from hepatitis C virus infection to nonalcoholic fatty liver disease. BMC Gastroenterol 2021; 21:245. [PMID: 34074270 PMCID: PMC8170924 DOI: 10.1186/s12876-021-01828-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/24/2021] [Indexed: 12/22/2022] Open
Abstract
Background Several trend analyses on liver transplantation (LT) indications have been published in the U.S. and in other countries, but there are limited data on LT indication trends in Saudi Arabia (SA), especially since the availability of direct-acting antivirals (DAAs) treatment for hepatitis C virus (HCV). This study aimed to analyze trends in the frequency of LT indications among LT recipients in SA over a 19-year period and examine associations between etiologic-specific trends and clinicodemographic characteristics. Methods This retrospective study analyzed clinical and surgical data of adult patients (n = 1009) who underwent LT at the King Faisal Specialist Hospital & Research Center (Riyadh, SA) between 2001 and 2019. Spearman’s rank correlation, Poisson regression, and Joinpoint regression analysis were employed to assess changes in LT etiologic trends. Results In the first period (2001–2010), the main LT indications were HCV (41.9%) and hepatitis B virus (HBV) (21.1%), but nonalcoholic steatohepatitis (NASH) (29.7%) surpassed HCV (23.7%) as the leading LT indication in the second period (2011–2019); and the trends were significant in correlation analyses [incidence rate ratio (IRR) = 1.09 (1.06–1.13) for NASH; IRR = 0.93 (0.91–0.95) for HCV]. In the Joinpoint regression analysis, increases in NASH from 2006 to 2012 (+ 32.1%) were statistically significant, as were the decreases in HCV from 2004 to 2007 (− 19.6%) and from 2010 to 2019 (− 12.1%). Similar patterns were observed in LT etiological comparisons before and after the availability of DAAs and within hepatocellular carcinoma stratifications. Conclusions Trends in the epidemiology of LT indications among LT recipients in SA have changed over a 19-year period. Most notably, NASH has eclipsed HCV in the country due to the effective treatment strategies for HCV. These trends in NASH now need an aggressive public health response to minimize and avert future onset of additional clinical and economic strains on health care systems and LT centers in SA.
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Affiliation(s)
- Saleh A Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. .,Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA.
| | - Dieter C Broering
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Saad A Alghamdi
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Khalid I Bzeizi
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | - Saleh I Alabbad
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ali Albenmousa
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Nasreen Alfaris
- Obesity, Endocrine, and Metabolism Center, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Faisal Abaalkhail
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed K Al-Hamoudi
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abbas Z, Abbas M. Challenges in Formulation and Implementation of Hepatitis B Elimination Programs. Cureus 2021; 13:e14657. [PMID: 33907651 PMCID: PMC8065944 DOI: 10.7759/cureus.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nearly 257 million individuals have contracted hepatitis B infection around the world. However, only 10% of them know about their illness. Mother to child transmission, nosocomial spread, and sexual transmission are the major etiological factors. Finding the missing millions is a global issue. Hepatitis B care is more difficult compared to hepatitis C as not all patients require treatment and the selection of patients is not straightforward. To eliminate hepatitis B infection, the program should screen pregnant women and start antiviral therapy from the 28th week of pregnancy if hepatitis B virus (HBV) DNA≥ 200,000 IU/mL or hepatitis B e-antigen (HBeAg) reactive. Prevention of perinatal infection, birth dose and neonatal vaccination, post-vaccination monitoring of high-risk groups, catch-up vaccination, and registration of the carriers should be an integral part of the program. Continuum of care is important when planning the elimination program from addressing the risk factors, testing, and referral for treatment. The program should integrate test and treat hepatitis services with existing local health care services. There is a need to create the right environment, raise awareness, remove stigma, and increase screening of those at risk and manage those who require treatment. A national policy should be prepared for capacity building, fund allocation, and implementation strategies. Micro-elimination strategies should boost national elimination effects. Guidelines to diagnose and treat patients with hepatitis B should be simplified. Surveillance should be done to monitor progress, and determine the impact of the elimination program on incidence and mortality, and services.
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Affiliation(s)
- Zaigham Abbas
- Gastroenterology and Hepatology, Dr. Ziauddin University Hospital, Karachi, PAK
| | - Minaam Abbas
- Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, GBR
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26
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Kondili LA, Craxì A, Aghemo A. Absolute targets for HCV elimination and national health policy paradigms: Foreseeing future requirements. Liver Int 2021; 41:649-655. [PMID: 33486885 DOI: 10.1111/liv.14796] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/10/2021] [Indexed: 12/18/2022]
Abstract
The World Health Organization (WHO) targets for eliminating HCV by 2030 may be overambitious for many high-income countries. Recent analyses (ie, data from 2017 to 2019) show that only 11 countries are on track for meeting WHO's elimination targets. For a country to be truly on track, it is important that the majority of infected individuals be identified and treated. There is still a need for country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and support an evidence-based policy for HCV elimination. Any health policy model is affected by the diversity and quality of the available data and by gaps in data. Given the differences among countries, comparing progress based on fixed global targets will not necessarily be suitable in the same measure for each country. In a recent document, the European Collaborators of Polaris Observatory provide insight into the limitations of the current WHO targets. The absolute targets identified by each country in accordance with the measures set by WHO would be essential in reaching the HCV elimination. All analytic models to assess the progress towards HCV elimination are based on projections to 2030 not including the impact of the COVID-19 pandemic on hepatitis-related services. With specific regard to the achievement of WHO hepatitis elimination goals, all measures that will be put in place during and after COVID-19 pandemic could be transferred in increasing diagnosis and linkage to care of people with hepatitis.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, Department of Internal Medicine and Medical Specialties "PROMISE", University of Palermo, Palermo, Italy
| | - Alessio Aghemo
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
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