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D'Ambrosio R, Anolli MP, Pugliese N, Masetti C, Aghemo A, Lampertico P. Prevalence of HCV infection in Europe in the DAA era: Review. Liver Int 2024; 44:1548-1563. [PMID: 38804727 DOI: 10.1111/liv.15981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
In 2016, the Global Health Sector Strategy, ratified by the 69th World Health Assembly, set the ambitious goal of eliminating hepatitis C virus (HCV) and hepatitis B virus infections by 2030, emphasizing the importance of national screening programmes. Achieving this goal depends on each country's ability to identify and treat 80% of chronic hepatitis C cases, a critical threshold set by the World Health Organization. Traditionally, estimates of HCV prevalence have been based on interferon era studies that focused on high-risk subgroups rather than the general population. In addition, the incomplete data available from national registries also limited the understanding of HCV prevalence. The 2016 report from the European Centre for Disease Prevention and Control highlighted that HCV rates varied across European counties, ranging from .1% to 5.9%. However, data were only available for 13 countries, making the overall picture less clear. Additionally, the epidemiological data may have underestimated the true burden of HCV due to lack of awareness among those with chronic infection. The main objective of this review is to provide a comprehensive summary of HCV epidemiology in Europe in the current era of direct-acting antivirals (DAAs). The data included in the analysis range from the end of 2013 to December 2023 and have been categorised according to the United Nations Geoscheme. The resulting synthesis underscores the noteworthy impact of DAA treatment on the epidemiological situation.
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Affiliation(s)
- Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria P Anolli
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Centre for Liver Disease, University of Milan, Milan, Italy
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Roder C, Cosgrave C, Mackie K, McNamara B, Doyle JS, Wade AJ. Missed Opportunities: A Retrospective Study of Hepatitis C Testing in Hospital Inpatients. Viruses 2024; 16:979. [PMID: 38932269 PMCID: PMC11209528 DOI: 10.3390/v16060979] [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: 04/30/2024] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Increasing testing is key to achieving hepatitis C elimination. This retrospective study aimed to assess the testing cascade of patients at a regional hospital in Victoria, Australia, who inject drugs or are living with hepatitis C, to identify missed opportunities for hepatitis C care. Adult hospital inpatients and emergency department (ED) attendees from 2018 to 2021 with indications for intravenous drug use (IDU) or hepatitis C on their discharge or ED summary were included. Data sources: hospital admissions, pathology, hospital pharmacy, and outpatients. We assessed progression through the testing cascade and performed logistic regression analysis for predictors of hepatitis C care, including testing and treatment. Of 79,923 adults admitted, 1345 (1.7%) had IDU-coded separations and 628 (0.8%) had hepatitis C-coded separations (N = 1892). Hepatitis C virus (HCV) status at the end of the study was unknown for 1569 (82.9%). ED admissions were associated with increased odds of not providing hepatitis C care (odds ratio 3.29, 95% confidence interval 2.42-4.48). More than 2% of inpatients at our hospital have an indication for testing, however, most are not being tested despite their hospital contact. As we work toward HCV elimination in our region, we need to incorporate testing and linkage strategies within hospital departments with a higher prevalence of people at risk of infection.
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Affiliation(s)
- Christine Roder
- Barwon South West Public Health Unit, Barwon Health, Geelong 3220, Australia;
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong 3220, Australia
| | - Carl Cosgrave
- Gastroenterology Department, Barwon Health, Geelong 3220, Australia;
| | - Kathryn Mackie
- Pharmacy Department, Barwon Health, Geelong 3220, Australia;
- Pharmacy Department, Alfred Health, Melbourne 3004, Australia
| | - Bridgette McNamara
- Barwon South West Public Health Unit, Barwon Health, Geelong 3220, Australia;
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong 3220, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia;
- Department of Infectious Disease, Alfred Health, Melbourne 3004, Australia
| | - Amanda J. Wade
- Barwon South West Public Health Unit, Barwon Health, Geelong 3220, Australia;
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong 3220, Australia
- Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia;
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Costa EG, Moratto A, Villalta D, Da Re M, Basaglia G, Tonizzo M, Grazioli S. HCV screening in hospitalized patients: new challenges and opportunities for the target of microelimination. LE INFEZIONI IN MEDICINA 2024; 32:116-118. [PMID: 38456032 PMCID: PMC10917562 DOI: 10.53854/liim-3201-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Elena Garlatti Costa
- Department of Internal Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone, Italy
| | - Anna Moratto
- Department of Immunology and Allergology, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone, Italy
| | - Danilo Villalta
- Department of Immunology and Allergology, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone, Italy
| | - Mirella Da Re
- Department of Immunology and Allergology, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone, Italy
| | - Giancarlo Basaglia
- Department of Microbiology and Virology, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone, Italy
| | - Silvia Grazioli
- Department of Internal Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone, Italy
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D'Ambrosio R, Piccinelli S, Beccalli B, Spinetti A, Puoti M, Fagiuoli S, Magni CF, Vavassori A, Sacchi P, Castaldi S, Bombardieri G, Farina C, Buoro S, Amorosi A, Corradin M, Cereda D, Lampertico P. A territory-wide opportunistic, hospital-based HCV screening in the general population from northern Italy: The 1969-1989 birth-cohort. Liver Int 2023; 43:2645-2656. [PMID: 37715524 DOI: 10.1111/liv.15727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND AND AIM The World Health Organization (WHO) goal of Hepatitis C Virus (HCV) elimination by 2030 rose awareness about the need of screening plans, worldwide. In Italy, graduated screening starting from people born in 1969-1989 might be the most-effective strategy. We performed an opportunistic HCV screening study in the general population attending health facilities in Lombardy region, Northern Italy. METHODS This is a prospective, multicenter, territory-wide, opportunistic study supported by the Regional Government of Lombardy, Italy. Between June 2022 and December 2022, all subjects born in 1969-1989, hospitalized or accessing blood collection centres were offered anti-HCV and HCV-RNA tests. Patients with known anti-HCV positivity and/or previous anti-HCV treatment were excluded. Demographic features were uploaded into a regional web-based platform. RESULTS In total, 120 193 individuals were screened in 75 centres. Mean age was 44 (±6) years, 65.2% were females, 83.7% were tested at blood collection centres. Anti-HCV tested positive in 604 (0.50%) subjects: mean age 47 (±5), 51.1% females. HCV seroprevalence was higher in males (p < 0.00001), elderly (p < 0.00001) and in- vs. outpatients (p = 0.0009). HCV-RNA was detectable in 125 out of 441 (28.3%) anti-HCV positive subjects. Actively infected patients were 46 (±6) years old, mainly males (56.8%). The overall prevalence of active HCV infection was 0.10%, higher in elderly (p = 0.0003) and in in-patients (p = 0.0007). Among 93 HCV-RNA positive patients, the median age was 48 years, 58% males, 62% Italian born, median HCV-RNA levels were 6,1 log IU/mL, liver stiffness measurement (LSM) values 5.5 (3.1-29.9) kPa and ALT levels 48 U/L. CONCLUSIONS The prevalence of active HCV infection in the 1969-1989 population attending health facilities in Lombardy was low. Most viremic patients were Italian-born, with mild liver disease but high-HCV-RNA levels. Due to the higher prevalence in the elderly, the extension of such opportunistic screening programs to lower birth cohorts would be warranted.
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Affiliation(s)
- Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Piccinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Angiola Spinetti
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, AAST Spedali Civili, Brescia, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, ASST GOM Niguarda, Milan, Italy
- Department of Medicine, University of Milan Bicocca, Milan, Italy
| | - Stefano Fagiuoli
- Department of Medicine, University of Milan Bicocca, Milan, Italy
- Division of Gastroenterology, Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Paolo Sacchi
- Division of Infectious Diseases, IRCCS San Matteo di Pavia, Pavia, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Quality Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Bombardieri
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | | | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Centre for Liver Disease, University of Milan, Milan, Italy
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Kondili LA, Rumi MG, Craxi A. Hospital HCV elimination in addition to universal precautions could reduce incidence and infection burden in Italy. J Hepatol 2023; 79:e187-e188. [PMID: 37121438 DOI: 10.1016/j.jhep.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
| | | | - Antonio Craxi
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
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Torre P, Coppola R, Masarone M, Persico M. Country-Wide HCV Elimination Strategies Need to Reach Older Patients in the General Population: The Italian Experience. Viruses 2023; 15:2199. [PMID: 38005877 PMCID: PMC10674437 DOI: 10.3390/v15112199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
HCV infection is still a major burden worldwide, and most countries are not on track to meet the WHO 2030 elimination goal. The current challenge is to identify individuals to be treated. In this study, we will describe the trend of new DAA prescriptions and the changes over time in terms of the characteristics of patients starting antiviral therapy in our unit. Data of 1646 hepatitis C patients who started therapy during the period of 2015-2022 regarding annual number of prescriptions, age, gender, nationality, HCV genotype, provenance, and liver disease severity were analyzed. We observed a peak in the number of new prescriptions in 2018 and a downward trend starting in 2019. Patients from the general population, centers for addictions, and prison differed significantly. The mean age in the general population remained above 60 years, the percentage of patients from centers for addictions and prison increased and, after 2016, there was no significant change in the percentage of patients with F3-F4 fibrosis. As HCV screening and linkage-to-care pathways seem to be already well implemented and successful in centers for addictions and in prisons, efforts need to be focused on those of older age in the general population. To carry this out, the more structured involvement of different health professionals must be figured out.
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Affiliation(s)
| | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Città d’Ippocrate, 84131 Salerno, Italy; (P.T.); (R.C.); (M.M.)
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Tsai WC, Chiang HC, Chiu YC, Chien SC, Cheng PN, Chiu HC. Chronic Hepatitis C Virus Infection: An Ongoing Challenge in Screening and Treatment. Life (Basel) 2023; 13:1964. [PMID: 37895346 PMCID: PMC10608250 DOI: 10.3390/life13101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
With the advent of direct-acting antiviral agents (DAA) in the recent few years, hepatitis C virus (HCV) infection has become a curable infectious disease. Successful clearance of HCV could lead to improvement of both hepatic and extrahepatic outcomes, such as complications of cirrhosis, hepatocellular carcinoma, cardiovascular diseases, and incident diabetes. However, challenges persist in reaching the HCV elimination goals of the World Health Organization by 2030. Among these challenges are identifying those already infected or undiagnosed subjects, re-linking to the care of known but untreated HCV-infected subjects, and developing strategies to enhance treatment rates and compliance in specific or high-risk populations. In addition, issues of post-DAA viral clearance, including avoiding or preventing reinfection in high-risk populations and surveillance of hepatocellular carcinoma, are important to consolidate the treatment's short- and long-term efficacies. In the current DAA era, treatment is the most effective prevention strategy not only in its excellent efficacy and safety but also in preventing HCV spread. All of the surveillance or measures should center on DAA treatment in clinical practice.
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Affiliation(s)
| | | | | | | | - Pin-Nan Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (W.-C.T.); (H.-C.C.); (Y.-C.C.); (S.-C.C.)
| | - Hung-Chih Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (W.-C.T.); (H.-C.C.); (Y.-C.C.); (S.-C.C.)
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Kondili LA, Craxì L, Nava F, Babudieri S, D'Ambrosio R, Marcellusi A, Mennini FS, Valle S, Russo P, Olimpieri PP, Andreoni M, Aghemo A. From Prioritization to Universal Treatment: Successes and Challenges of Hepatitis C Virus Elimination in Italy. J Infect Dis 2023; 228:S211-S220. [PMID: 37703346 DOI: 10.1093/infdis/jiad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Italy has had the highest prevalence of hepatitis C virus (HCV) infection and mortality from HCV-related liver cancer in Europe. Although direct-acting antivirals (DAA) were initially restricted to persons with advanced fibrosis, their use has since been extended to all infected individuals; more than 244 000 persons have been treated to date. HCV liver-related mortality is expected to decline by 75% by 2030, achieving the World Health Organization target for mortality. However, Italy risks failing to meet the overall goal of eliminating HCV infection by 2030. In this light, €71.5 million have been allocated for screening initially specific target populations (persons who inject drugs, prison inmates, and the 1969-1989 birth cohort). Herein, we outline the challenges and recommendations for how to move Italy toward HCV elimination, including expanding screening programs in other populations, increasing awareness through strategic communication, sustaining DAA access, and tailoring care models to meet the needs of key populations.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanita, Rome, Italy
- Degree Course in Dentistry and Dental Prosthetics, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Lucia Craxì
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Felice Nava
- Health Care and Drug Abuse Unit in Prison, Public Health Agency, Padua, Italy
- Federazione Italiana degli Operatori dei Dipartimenti e dei Servizi delle Dipendenze, Milan, Italy
| | - Sergio Babudieri
- Infectious and Tropical Disease Unit, University Hospital of Sassari, Sassari, Italy
- Italian Society of Penitentiary Health Medicine, Viterbo, Italy
| | - Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Marcellusi
- Economic Evaluation and Health Technology Assessment, Centre for Economic and International Studies, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and Health Technology Assessment, Centre for Economic and International Studies, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
- Institute of Leadership and Management in Health, Kingston Business School, Kingston University, London, United Kingdom
- Italian Society of Health Technology Assessment, Rome, Italy
| | - Sabrina Valle
- General Directorate for Health Prevention, Prevention of Communicable Diseases and International Prophylaxis, Italian Ministry of Health, Rome, Italy
| | - Pierluigi Russo
- Health Economic Evaluations Office, Italian Medicines Agency, Rome, Italy
- Monitoring Registers Office, Italian Medicines Agency, Rome, Italy
| | | | - Massimo Andreoni
- Infectious Diseases Clinic, University Hospital Tor Vergata, Rome, Italy
- Italian Society of Infectious and Tropical Diseases, Prato, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Isituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, 20089, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Italian Association for the Study of the Liver, Rome, Italy
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Roder C, Cosgrave C, Mackie K, Roberts SK, Hellard ME, Wade AJ, Doyle JS. Leave No-One Behind: A Retrospective Study of Hepatitis C Testing and Linkage to Care for Hospital Inpatients. Viruses 2023; 15:v15040913. [PMID: 37112893 PMCID: PMC10141486 DOI: 10.3390/v15040913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Hospital admissions are a missed opportunity to engage people living with hepatitis C virus (HCV) into care. This study aimed to describe the proportion of hospital inpatients and emergency department (ED) patients identified with hepatitis C who were subsequently linked to care and treatment at a metropolitan health service in Melbourne, Australia. Data were collected retrospectively from hospital databases (admissions, notifiable diseases, and pharmacy) for all adults admitted or attending the ED with separation coding indicating hepatitis C infection from March 2016 to March 2019. There were 2149 patients with at least one separation with hepatitis C coding. 15.4% (331/2149) had a documented antibody test, 4.6% (99/2149) had a documented RNA test, and 8.3% (179/2149) had a DAA prescription dispensed by hospital pharmacy. Antibody positivity was 95.2% (315/331) and RNA (when completed) was detected in 37.4% (37/99). Hepatitis specialist units had the highest rate of hepatitis C coded separations and RNA testing (39/88; 44.3%), mental health had the highest rate of antibody testing (70/276; 25.4%). Emergency had the lowest rate of antibody testing (101/1075; 13.7%) and the third highest rate of RNA testing (32/94; 34.1%), but the highest rate of RNA detected (15/32; 46.9%). This study highlights key steps to improve the care cascade. Simplified diagnostic pathways, expansion of hepatitis C care services, and clear in-hospital pathways to link patients to care would be beneficial in this setting. To scale up hepatitis C testing and treatment as part of national elimination strategies, hospital systems need to target interventions to their local data.
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Affiliation(s)
- Christine Roder
- Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong 3220, Australia
- Barwon South West Public Health Unit, Barwon Health, Geelong 3220, Australia
| | - Carl Cosgrave
- Barwon South West Public Health Unit, Barwon Health, Geelong 3220, Australia
| | - Kathryn Mackie
- Barwon South West Public Health Unit, Barwon Health, Geelong 3220, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne 3004, Australia
| | | | - Amanda J. Wade
- Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong 3220, Australia
- Barwon South West Public Health Unit, Barwon Health, Geelong 3220, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia
- Department of Infectious Disease, Alfred Health and Monash University, Melbourne 3004, Australia
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Hepatitis C Virus Micro-Elimination Plan in Southern Italy: The "HCV ICEberg" Project. Pathogens 2023; 12:pathogens12020195. [PMID: 36839474 PMCID: PMC9967587 DOI: 10.3390/pathogens12020195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
This study evaluates the feasibility of a local action program for HCV micro-elimination in highly endemic areas. Retrospective analysis: administrative and laboratory data (Local Health Unit, southern Italy) were integrated to quantize the anti-HCV-positive subjects not RNA tested and untreated HCV-infected subjects (2018-2022). Prospective analysis: all subjects admitted to a division of the LHU largest hospital (2021-2022) were tested for HCV, with linkage of active-infected patients to care. Overall, 49287 subjects were HCV-Ab tested: 1071 (2.2%) resulted positive without information for an HCV RNA test and 230 (0.5%) had an active infection not yet cured. Among 856 admitted subjects, 54 (6.3%) were HCV-Ab+ and 27 (3.0%) HCV RNA+. Of HCV-infected patients, 22.2% had advanced liver disease, highlighting the need for earlier diagnosis; 27.7% were unaware of HCV infection; and 20.4% were previously aware but never referred to a clinical center. Of these, 26% died and 74% received treatment. Our study emphasizes the value of an active HCV hospital case-finding program to enhance diagnosis in patients with several comorbidities and to easily link them to care. Our data strongly suggest extending this program to all hospital wards/access as a standard of care, particularly in highly endemic areas, to help HCV disease control and take steps in achieving the elimination goals.
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Ways to Eliminate Viral Hepatitis as a Global Health Threat. Viruses 2022; 14:v14071554. [PMID: 35891534 PMCID: PMC9317760 DOI: 10.3390/v14071554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
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