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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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2
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Estirado Gómez A, Justo Gil S, Limia A, Avellón A, Arce Arnáez A, González-Rubio R, Diaz A, Del Amo J. Prevalence and undiagnosed fraction of hepatitis C infection in 2018 in Spain: results from a national population-based survey. Eur J Public Health 2021; 31:1117-1122. [PMID: 34392348 DOI: 10.1093/eurpub/ckab069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A national strategy against hepatitis C virus (HCV) was implemented in Spain in 2015 with the aim of reducing associated morbidity and mortality. In order to improve our understanding of the epidemiology of HCV, we analysed the prevalence of HCV antibodies and active infection overall and by age and sex in the general population aged 20-80 years. We also aimed to report the undiagnosed fraction. METHODS A national population-based seroprevalence survey was conducted in 2017-2018. A representative sample from the general population was selected using two-stage sampling. The prevalence of total HCV antibodies and of HCV RNA was calculated using inverse probability weighting based on bootstrapping. RESULTS Overall, we approached 17 496 persons; 9103 agreed to participate and met the eligibility criteria and 7675 were aged 20-80. We obtained a prevalence of HCV antibodies of 0.85% [95% confidence interval (CI): 0.64-1.08%] and of active infection of 0.22% (95% CI: 0.12-0.32%). The prevalence of active HCV infection was highest in men aged 50-59 (0.86%; 95% CI: 0.28-1.57%) and in men aged 60-69 years (0.72%; 95% CI: 0.27-1.28%). Prevalence was below 0.20% in the remaining age groups. The undiagnosed fraction for active HCV infection was 29.4%. CONCLUSION This study shows that prevalence of HCV in the general population in Spain is low and reflects the impact of scaling up treatment with direct acting antivirals, together with other prevention strategies, from 2015 onwards. The data reported can guide subsequent public health actions.
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Affiliation(s)
- Alicia Estirado Gómez
- Health Information, General Secretariat for Digital Health, Information and Innovation, Ministry of Health, Madrid, Spain
| | - Soledad Justo Gil
- Health Promotion, Prevention and Quality, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Aurora Limia
- Health Promotion, Prevention and Quality, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Ana Avellón
- National Center for Microbiology, Institute of Health Carlos III, CIBERESP, Madrid, Spain
| | - Araceli Arce Arnáez
- Health Information, General Secretariat for Digital Health, Information and Innovation, Ministry of Health, Madrid, Spain
| | - Raquel González-Rubio
- National Plan against HIV & STIs & Viral Hepatitis & TB, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Asunción Diaz
- National Plan against HIV & STIs & Viral Hepatitis & TB, General Directorate of Public Health, Ministry of Health, Madrid, Spain.,HIV, HCV & STI Surveillance, National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Julia Del Amo
- National Plan against HIV & STIs & Viral Hepatitis & TB, General Directorate of Public Health, Ministry of Health, Madrid, Spain
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3
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Casas MDLP, García F, Freyre-Carrillo C, Montiel N, de la Iglesia A, Viciana I, Domínguez A, Guillot V, Muñoz A, Cantudo P, Franco-Álvarez F, Reguera JA, Romera MA, Cabezas T, Vargas J, Ramírez-Arcos M, Guerrero I, García-Navarrete Á, Pérez-Santos MJ, Clavijo E, Roldán C, Guzmán A, Palanca M, Torres E, Serrano MDC, Lozano MDC, Becerril B, Luzón P, Galán MÁ, Alados JC, García F. Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:515-519. [PMID: 32188257 DOI: 10.17235/reed.2020.6370/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.
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Affiliation(s)
- María de la Paz Casas
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs, España
| | - Fernando García
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de I
| | | | | | | | - Isabel Viciana
- Servicio de Microbiología, Hospital Universitario Virgen de la Victoria
| | - Ana Domínguez
- Servicio de Microbiología, Hospital Juan Ramón Jiménez
| | | | - Aurora Muñoz
- Servicio de Microbiología, Hospital San Juan de la Cruz
| | | | | | | | | | - Teresa Cabezas
- Servicio de Microbiología, Hospital Universitario Torrecárdenas
| | - Julio Vargas
- Servicio de Microbiología, Hospital Universitario Virgen de Valme
| | | | | | | | | | | | | | | | | | - Eva Torres
- Servicio de Microbiología, Hospital Universitario de Jerez de la Frontera
| | | | | | | | - Pilar Luzón
- Servicio de Microbiología, Hospital La Inmaculada
| | | | - Juan Carlos Alados
- Servicio de Microbiología, Hospital Universitario de Jerez de la Frontera
| | - Federico García
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs
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4
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Burgui C, Martín C, Aguinaga A, Pérez-García A, Ezpeleta C, Castilla J. Prevalence and detection of undiagnosed active hepatitis C virus infections in Navarre, Spain, 2017-2019. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:28-34. [PMID: 33207891 DOI: 10.17235/reed.2020.7000/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND undiagnosed active hepatitis C virus (HCV) infection remains an obstacle towards its eradication. This study aimed to estimate the prevalence of HCV infection and to describe the diagnostic advances in Navarre, Spain. METHODS HCV-infection diagnostic performance was analyzed in Navarre's primary and specialized health care between 2017 and 2019. The prevalence of undiagnosed infections was estimated for patients with programmed surgeries unrelated to HCV infection, who underwent a routine HCV antibody (anti-HCV) determination. HCV-RNA (viral load) was quantified in anti-HCV positive cases. The prevalence was standardized according to the sex and age distribution in the general population. RESULTS from the 63,405 subjects examined for anti-HCV, 84 (five per 100,000 person-years) were diagnosed with an active infection. In Primary Health Care, 20,363 patients were analyzed and 47 active infections were detected, i.e. one case for every 433 people tested, implying 56 % of all identified active infections. On the other hand, 9,399 surgical patients were analyzed and 120 anti-HCV positive cases were detected (adjusted prevalence: 1.47 %; 95 % CI: 1.24-1.52). A positive viral load had been determined at any time in 66 cases (0.61 %), of which five were undiagnosed active infections (adjusted prevalence: 0.04 %; 95 % CI: 0.01-0.11). Preoperative screening allowed the detection of one undiagnosed infection per 795 people analyzed aged between 45 and 64 years. CONCLUSIONS Primary Health Care efficiently contributes to the detection of undiagnosed HCV active infections. This may be speeded up by performing population screening, targeting subjects between 45 and 64 years of age.
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Affiliation(s)
- Cristina Burgui
- Epidemiología, Instituto de Salud Pública de Navarra, España
| | - Carmen Martín
- Microbiología Clínica, Complejo Hospitalario de Navarra
| | | | | | | | - Jesús Castilla
- Epidemiología, Instituto de Salud Pública y Laboral de Navarra, España
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Guerra Veloz MF, Del Pino Bellido P, Cordero Ruiz P, Vega Rodriguez F, Bellido Muñoz F, Ramirez de Arellano E, Caunedo Álvarez A, Pascual Hernandez A, Carmona Soria I. HCV microelimination strategies: An interventional study in diagnosed patients without access to the system. Liver Int 2021; 41:928-933. [PMID: 33587789 DOI: 10.1111/liv.14824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/13/2021] [Accepted: 02/11/2021] [Indexed: 12/16/2022]
Abstract
Hepatitis C virus (HCV) one-step diagnosis improves recovery in patients with active infection. However, patients with previous anti-HCV+ may be excluded. We aimed to identify and retrieve non-referred or lost-to-follow-up HCV-infected patients. All anti-HCV+ patients seen in our hospital between 2013 and 2018 were included. In the first phase, we identified anti-HCV+ patients who were not referred to the Gastroenterology Unit (GU) or lost-to-follow-up. In the second phase, recovered patients were invited for a one-step visit for liver evaluation. A total of 1330 anti-HCV+ patients were included: 21.7% had not been referred to GU, and 23.1% were lost-to-follow-up. In the second phase, 49.6% of patients were contacted, and 92.8% attended a medical consultation: 62.7% had active infection, 92.2% were treated, and 86.5% achieved SVR (ITT). We concluded that screening microbiological data and referring unidentified patients with active HCV infection directly to specialists is an effective tool in achieving HCV microelimination.
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Affiliation(s)
| | | | - Patricia Cordero Ruiz
- Gastroenterology and Hepatology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | | | | | | | | | - Isabel Carmona Soria
- Gastroenterology and Hepatology Department, Virgen Macarena University Hospital, Seville, Spain
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6
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Reyes-Urueña J, Celly A, Moreno S, Majó X, Colom J, Casabona J. Hepatitis C virus: Testing rate and attrition at linkage to specialized care, Catalonia, Spain 2011-2016. J Viral Hepat 2021; 28:288-299. [PMID: 33098176 DOI: 10.1111/jvh.13427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 01/11/2023]
Abstract
Hepatitis C virus (HCV) screening through primary care providers (PCP) might increase linkage to specialized care. This study aimed to calculate HCV testing rate and prevalence of anti-HCV according to socio-demographic factors in primary care in Catalonia, Spain, from 2011 to 2016, and to identify the rate and determinants of attrition at linkage to specialized care. Patient data from 274 primary care centres (3414 PCP) were analysed, including socio-demographic information, morbidity, laboratory tests and treatments (1-Jan-2011 to 31-Dec-2016). Both descriptive and inferential statistics were used to examine HCV testing rate, HCV seroprevalence and rate of attrition at linkage to specialized care. In the study period, there were 839 072 people tested for HCV infection and 21 156 with first-time positive anti-HCV test results. Rate of HCV testing was 143.54/103 pop (95% CI: 143.26-143.83). Women had higher HCV testing rate (158.65/103 women [95% CI: 158.24-159.07]), compared to men (128.10/103 men [95% CI: 127.72-128.49]). The highest HCV testing rate was among people aged 25-34 (284.11/103 pop [CIs: 283.10-285.12]). The anti-HCV seroprevalence was 3.62/103 pop (CIs: 3.57-3.67). The highest prevalence was found among men (4.20/103 men [CIs: 4.12-4.27]), people aged 45-54 (7.19/103 pop [CIs: 7.01-7.37]), people aged 75-84 (7.26/103 pop [CIs: 6.99-7.53]), Spanish (3.68/103 [CIs: 3.61-3.75]), European and Northern Americans (5.64/103 [CIs: 5.33-5.96]) and Asians (9.78/103 [CIs: 9.21-10.35]). From those who had a positive anti-HCV result, 49.8% (N = 10 528) were not linked to specialized care. Appropriate clinical care pathways and referral systems need to be established to ensure optimal linkage to specialized care for people newly diagnosed with HCV in primary care.
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Affiliation(s)
- Juliana Reyes-Urueña
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain
| | - Ana Celly
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain.,Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sergio Moreno
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain
| | - Xavier Majó
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV), (PCVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Joan Colom
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV), (PCVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Jordi Casabona
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain.,Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
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7
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Cabezas J, García F, Calleja Panero JL, Buti M, Molero García JM, Blasco AJ, Lázaro de Mercado P, Crespo J. Principles for implementing a population screening strategy for hepatitis C in Spain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:64-70. [PMID: 31880160 DOI: 10.17235/reed.2019.6768/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND hepatitis C, besides health impairment, results in significant loss of productivity and diminished quality of life, and noticeably contributes to health expenditure increases. Because of all this, the Spanish Ministry of Health (Ministerio de Sanidad, Consumo y Bienestar Social - MSCBS) implemented in 2015 a strategic plan for managing hepatitis C (Plan Estratégico para el Abordaje de la Hepatitis C - PEAHC) within the National Health System. However, the PEAHC includes no screening plan. The MSCBS developed a framework document on population screening (Documento Marco sobre Cribado Poblacional) that defines the criteria a disease must meet in order to consider implementing a screening program. Specifically, it defines 4 criteria related to the health issue, 4 related to the screening test, and 3 criteria dealing with diagnosis confirmation and treatment. OBJECTIVE to identify whether there is scientific evidence to support hepatitis C meeting the criteria to be considered a disease qualifying for a population screening strategy in Spain. METHODS a literature search for scientific evidence concerning each required criterion for implementing a population screening plan for hepatitis C in Spain. RESULTS sufficient scientific evidence was found to support hepatitis C meeting the criteria required by the MSCBS for the implementation of a population screening program. CONCLUSIONS according to the available scientific evidence, hepatitis C in Spain meets the required criteria to qualify for consideration of population screening plan.
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Affiliation(s)
- Joaquín Cabezas
- Aparato Digestivo/Unidad de Hepatología, Hospital Universitario Marqués de Valdecilla, España
| | - Federico García
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs
| | - José Luis Calleja Panero
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro Majadahonda
| | - María Buti
- Servicio de Aparato Digestivo, Hospital Universitari Vall d´Hebron
| | | | | | | | - Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, 39002
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8
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Rodríguez-Tajes S, Domínguez Á, Carrión JA, Buti M, Quer JC, Morillas RM, López C, Torras X, Baliellas C, Vergara M, Forner M, Zaragoza N, Salò J, Rigau J, Caballeria L, Mariño Z, Janè M, Colom J, Forns X, Lens S. Significant decrease in the prevalence of hepatitis C infection after the introduction of direct acting antivirals. J Gastroenterol Hepatol 2020; 35:1570-1578. [PMID: 31957902 DOI: 10.1111/jgh.14984] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/20/2019] [Accepted: 01/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Accurate information on the epidemiology of hepatitis C and B infection is mandatory to establish a national/regional plan. We aim to update the prevalence of hepatitis C and B infection in Catalonia using point-of-care tests to analyze the risk factors related and to implement a linkage-to-care circuit. METHODS This is a community-based study. A random list of adult individuals was retrieved from censuses of primary care centers. Point-of-care tests for anti-hepatitis C virus (HCV) and HBV surface antigen (HBsAg) and a questionnaire for risk factor assessment were performed. Positive results were validated and a circuit for linkage-to-care was established. RESULTS A total of 3328 individuals were included. The anti-HCV and HBsAg overall prevalence were lower than expected [1.02%, 95% confidence interval (CI) 0.65-1.39; and 0.52%, 95% CI 0.26-0.77, respectively]. Anti-HCV positive subjects were mostly (88%) autochthonous. The prevalence increased with age; only 12% were under age 40. The associated risk factors were drug use, blood transfusion, relative with HCV, and diabetes. Notably, the prevalence of active infection was only 0.49% (95% CI 0.23-0.74), 40% less than previously reported, reflecting the impact of direct acting antiviral therapy. Differently, HBsAg positive subjects were mostly foreign migrants (53%) with no other risk factors. Despite the implementation of a linkage-to-care circuit, one third of HBsAg positive subjects were lost. CONCLUSIONS The prevalence of HCV infection was lower than previously reported, showing a strong impact of direct acting antiviral therapy in the last years. Because of hepatitis B universal vaccination, HBV infection in Catalonia is mainly associated with migrant population. Linkage-to-care in patients with hepatitis B was challenging and warrants additional efforts.
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Affiliation(s)
- Sergio Rodríguez-Tajes
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
| | - Ángela Domínguez
- Medicine Department, University of Barcelona and CIBERESP, Barcelona, Spain
| | - Jose Antonio Carrión
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital del Mar, Barcelona, Spain
| | - María Buti
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron and CIBEREHD, Barcelona, Spain
| | - Joan Carles Quer
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Rosa M Morillas
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Germans Trias i Pujol, IGTP, CIBEREHD, Autonomous University of Barcelona, Barcelona, Spain
| | - Carme López
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Josep Trueta, Girona, Spain
| | - Xavier Torras
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Santa Creu iSant Pau and CIBEREHD, Barcelona, Spain
| | - Carme Baliellas
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Bellvitge, Barcelona, Spain
| | - Merche Vergara
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Parc Taulí, Sabadell, Spain
| | - Montse Forner
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Mutua de Terrassa, Terrassa, Spain
| | - Natividad Zaragoza
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Arnau Vilanova, Lleida, Spain
| | - Joan Salò
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital de Vic, Vic, Spain
| | - Joaquim Rigau
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Granollers, Granollers, Spain
| | - Llorenç Caballeria
- Societat Catalana de Digestologia, Barcelona, Spain.,Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
| | - Mireia Janè
- Program for the Prevention, Control and Care of HIV, Sexually Transmitted Infections and Viral Hepatitis, Public Health Agency of Catalonia, Barcelona, Spain
| | - Joan Colom
- Program for the Prevention, Control and Care of HIV, Sexually Transmitted Infections and Viral Hepatitis, Public Health Agency of Catalonia, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
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9
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Alarcón Linares ME, Torres Cantero A, Subirá C, Ramírez Rubio O, Crespo J, Lazarus JV, Requena-Méndez A. Geographic analysis and estimation of hepatitis C cases in migrant populations living in Spain: is a country-based screening strategy appropriate? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:615-625. [PMID: 31317761 DOI: 10.17235/reed.2019.6117/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spain needs to increase the number of new known cases in order to achieve the goal of eliminating hepatitis C virus (HCV) by 2030. The aim of this study was to estimate the number of HCV cases among the migrant population in Spain and propose different scenarios for micro-elimination strategies, targeting the most relevant migrant groups. METHODOLOGY this epidemiological and demographic cross-sectional descriptive study employed a systematic approach to estimate the number of migrants infected by HCV in Spain. Estimates are based on demographic data and details the size of the foreign-born population living in every Spanish province and the anti-HVC+ prevalence rates in their respective countries of origin. RESULTS in Spain, there are 100,268 estimated cases of anti-HCV+ among the total adult migrant population who live in the country. The estimated cases of anti-HCV+ among migrants from moderate-high endemic countries with a prevalence of ≥ 2%, > 3%, > 4% and > 5% are 48,979, 48,029, 24,176 and 15,646, respectively. The anti-HCV+ endemic countries (≥ 2%) that contribute to the highest number of estimated cases in Spain are Romania, Italy, Pakistan, Ukraine, Senegal, Russia and Nigeria. The autonomous communities with the highest prevalence and number of estimated anti-HCV+ cases among migrant population are Catalonia, Valencian Community, Madrid and Andalusia, respectively. CONCLUSION these data show the need to establish HCV screening strategies for the migrant population in Spain and, particularly, in the most affected areas. The strategy should target those migrant communities with a higher prevalence and a higher number of estimated cases, such as people from Eastern Europe, Sub-Saharan Africa and Pakistan.
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Affiliation(s)
| | | | - Carme Subirá
- Barcelona Institute for Global Health, (ISGlobal-CRESIB, Hospital Clínic-Universitat de Barcelona, SPAIN
| | - Oriana Ramírez Rubio
- Barcelona Institute for Global Health, (ISGlobal-CRESIB, Hospital Clínic-Universitat de Barcelona, SPAIN
| | - Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander., SPAIN
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, (ISGlobal-CRESIB, Hospital Clínic-Universitat de Barcelona, SPAIN
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health, (ISGlobal-CRESIB, Hospital Clínic-Universitat de Barcelona, SPAIN
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10
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Marco A, Domínguez-Hernández R, Casado MA. Cost-effectiveness analysis of chronic hepatitis C treatment in the prison population in Spain. ACTA ACUST UNITED AC 2020; 22:66-74. [PMID: 32697276 PMCID: PMC7537362 DOI: 10.18176/resp.00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022]
Abstract
Objectives To evaluate the cost-effectiveness of direct-acting antiviral (DAAs) treatment versus non-treatment in prisoners awaiting treatment for chronic hepatitis C (CHC) and to analyse the clinical and economic impact of the treatment on liver complications and mortality. Material and method A lifetime Markov model was developed to simulate treatment and disease progression from an estimated cohort of 4,408 CHC prisoners treated with DAAs over 2 years (50% of patient each year) versus no treatment. In the treated cohort, a sustained viral response of 95% was associated. Patient characteristics, transition probabilities, utilities and costs (pharmacological and healthcare states) were obtained from published literature. The model estimated healthcare costs and benefits, incremental cost-utility ratio (ICUR) based on total costs and the quality-adjusted life year (QALY) and avoided clinical events. A National Healthcare System perspective was adopted with a 3% annual discount rate for both costs and health outcomes. Sensitivity analyses were performed to assess uncertainty. Results In the DDA treated cohort, the model estimated a decrease of 92% of decompensated cirrhosis and 83% of hepatocellular carcinoma, 88% liver-related mortality cases were reduced, 132 liver transplants were avoided. The treatment achieved an additional 5.0/QALYs (21.2 vs. 16.2) with an incremental cost of €3,473 (€24,088 vs. €20,615) per patient with an ICUR of €690 per QALY gained. Discussion Considering the willingness-to-pay threshold used in Spain (€22,000-30,000/QALY), DAAs treatment for prisoners with CHC is a highly cost-effective strategy, reduces infection transmission, increases survival and reduces complications due to liver disease, as well as the cost associated with its management.
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Affiliation(s)
- A Marco
- Prison Health Program. Institut Català de La Salut. Barcelona. Spain
| | | | - M A Casado
- Pharmacoeconomics & Outcomes Research Iberia (PORIB). Madrid. Spain
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11
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Calleja JL, Bermúdez Á, Camacho Á, Cárdenas F, Fernández S, de Juan J, Jorquera F, Linares M, Rodríguez MÁ, Romero M, Ruiz JJ, José Sánchez M, de la Vega J. Optimisation in the multidisciplinary approach to patients with hepatitis C in the era of direct-acting antivirals. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 42 Suppl 1:8-13. [PMID: 32560771 DOI: 10.1016/s0210-5705(20)30182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The advents of current direct-acting antiviral treatments has revolutionised the therapeutic approach to hepatitis C, increasing cure rates to above 90% and substantially simplifying treatment, which translates into benefits for patients, clinicians and the health system. These new drugs allow cure to be achieved, irrespective of the patient's characteristics, with tolerability similar to that of placebo and few drug reactions with concomitant medication. This in turn improves patients' quality of life and wellbeing. Moreover, these drugs allow multidisciplinary optimisation of the approach to patients with hepatitis C, thus reducing both short- and long-term costs. All these factors facilitate treatment universality, with treatments that are less influenced by specific factors and that allow better results to be obtained in a larger number of patients. Elimination of hepatitis C is now a real possibility. Supplement information: This article is part of a supplement entitled "The value of simplicity in hepatitis C treatment", which is sponsored by Gilead. © 2019 Elsevier España, S.L.U. All rights reserved.
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Affiliation(s)
- José Luis Calleja
- Servicio de Gastroenterología, Hospital General Universitario Puerta de Hierro, Madrid, España.
| | - Ángeles Bermúdez
- Enfermera de Consulta de Digestivo, Hospital de San Agustín, Avilés, Asturias, España
| | - Ángela Camacho
- Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, España
| | | | - Sergio Fernández
- Servicio de Farmacia Hospitalaria, Hospital Comarcal de Antequera, Málaga, España
| | - José de Juan
- Médico de Atención Primaria, Centro Penitenciario Córdoba, Córdoba, España
| | - Francisco Jorquera
- Servicio de Digestivo, Complejo Asistencial Universitario León, IBIOMED, CIBERehd, España
| | - Manuel Linares
- Médico de Atención Primaria, Centro de Salud Buenos Aires, Madrid, España
| | | | - Miriam Romero
- Servicio de Digestivo, Hospital Universitario La Paz, Madrid, España
| | - Juan Jesús Ruiz
- Médico de Atención Primaria Especialista en Adicciones, CTA Málaga, Málaga, España
| | - M José Sánchez
- Enfermera de Consulta de Digestivo, Hospital Universitario de Donostia, San Sebastián, España
| | - Juan de la Vega
- Servicio de Digestivo, Hospital Universitario San Agustín, Avilés, Asturias, España
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12
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Ruiz-Extremera Á, Díaz-Alcázar MDM, Muñoz-Gámez JA, Cabrera-Lafuente M, Martín E, Arias-Llorente RP, Carretero P, Gallo-Vallejo JL, Romero-Narbona F, Salmerón-Ruiz MA, Alonso-Diaz C, Maese-Heredia R, Cerrillos L, Fernández-Alonso AM, Camarena C, Aguayo J, Sánchez-Forte M, Rodríguez-Maresca M, Pérez-Rivilla A, Quiles-Pérez R, Muñoz de Rueda P, Expósito-Ruiz M, García F, García F, Salmerón J. Seroprevalence and epidemiology of hepatitis B and C viruses in pregnant women in Spain. Risk factors for vertical transmission. PLoS One 2020; 15:e0233528. [PMID: 32437468 PMCID: PMC7241747 DOI: 10.1371/journal.pone.0233528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background & aim Worldwide, measures are being implemented to eradicate hepatitis B (HBV) and C (HCV) viruses, which can be transmitted from the mother during childbirth. This study aims to determine the prevalence of HBV and HCV in pregnant women in Spain, focusing on country of origin, epidemiological factors and risk of vertical transmission (VT). Methodology Multicentre open-cohort study performed during 2015. HBV prevalence was determined in 21870 pregnant women and HCV prevalence in 7659 pregnant women. Epidemiological and risk factors for VT were analysed in positive women and differences between HBV and HCV cases were studied. Results HBV prevalence was 0.42% (91/21870) and HCV prevalence was 0.26% (20/7659). Of the women with HBV, 65.7% (44/67) were migrants. The HBV transmission route to the mother was unknown in 40.3% of cases (27/67) and VT in 31.3% (21/67). Among risk factors for VT, 67.7% (42/62) of the women had viraemia and 14.5% (9/62) tested HBeAg-positive. All of the neonates born to HBV-positive mothers received immunoprophylaxis, and none contracted infection by VT. In 80% (16/20) of the women with HCV, the transmission route was parenteral, and nine were intravenous drug users. Viraemia was present in 40% (8/20) of the women and 10% (2/20) were HIV-coinfected. No children were infected. Women with HCV were less likely than women with HBV to breastfeed their child (65% vs. 86%). Conclusions The prevalences obtained in our study of pregnant women are lower than those previously documented for the general population. Among the women with HBV, the majority were migrants and had a maternal family history of infection, while among those with HCV, the most common factor was intravenous drug use. Despite the risk factors observed for VT, none of the children were infected. Proper immunoprophylaxis is essential to prevent VT in children born to HBV-positive women.
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Affiliation(s)
- Ángeles Ruiz-Extremera
- Hospital Universitario San Cecilio, Granada, Spain
- CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD), CIBER, Madrid, Spain
- Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | | | | | | | | | | | | | | | | | | | - Clara Alonso-Diaz
- Hospital Universitario Doce de Octubre, Madrid, Spain
- RED SAMID (ISCIII ref. RD/16/0022), Spain
| | | | | | | | | | - Josefa Aguayo
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | - Paloma Muñoz de Rueda
- Hospital Universitario San Cecilio, Granada, Spain
- CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD), CIBER, Madrid, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Manuela Expósito-Ruiz
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Unidad de Apoyo a la Investigación, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain
| | - Federico García
- Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- RED de SIDA (ISCIII ref. RD/16/0025/0040), Spain
| | - Fernando García
- Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- RED de SIDA (ISCIII ref. RD/16/0025/0040), Spain
| | - Javier Salmerón
- Hospital Universitario San Cecilio, Granada, Spain
- CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD), CIBER, Madrid, Spain
- Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
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13
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Carvalho-Gomes Â, Cubells A, Pallarés C, Hontangas V, Conde I, Di Maira T, Peiró S, Sanfélix-Gimeno G, López-Labrador FX, Berenguer M. A population-based screening for hepatitis C antibodies and active infection using a point-of-care test in a low prevalence area. PLoS One 2020; 15:e0228351. [PMID: 32045417 PMCID: PMC7012430 DOI: 10.1371/journal.pone.0228351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Data on the true prevalence of hepatitis C virus (HCV) infection in the general population is essential. We evaluated a program implementing free universal HCV screening using a non-invasive point-of-care test (POCT) (OraQuick-HCV rapid test) in oral fluid in an urban area in Valencia, South-Eastern Spain. Methods A cross-sectional study was performed during 2015–2017. Free HCV screening was offered by regular mail to 11,500 individuals aged 18 and over, randomly selected from all census residents in the Health Department. All responding participants filled in a questionnaire about HCV infection risk factors and were tested in their tertiary Hospital. In those with a positive POCT, results were confirmed by enzyme-immunoassay and HCV-RNA. Results 1,206 persons agreed to participate (response rate: 11.16%). HCV antibodies were detected in 19 (1.60%) cases (age-sex standardized rate: 1.31%; 95%CI: 0.82–2.07), but only 8 showed positive HCV-RNA (age-sex standardized rate: 0.56%; 95%CI: 0.28–1.14). The majority (89%) of the cases were born before 1965 and 74% had at least one known risk factor for HCV infection. All anti-HCV positive individuals were already aware of their infection, and no undiagnosed cases were detected. The performance of the POCT was excellent for detecting active infection. Conclusions These preliminary data suggest that HCV population screening with a POCT is feasible but, in our setting, mailing recruiting is not effective (11% response rate). The low prevalence of HCV antibodies and active infection in the participant population (with no new diagnoses made) suggests that, in our setting, underdiagnosis may be uncommon.
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Affiliation(s)
- Ângela Carvalho-Gomes
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Almudena Cubells
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
| | - Carmina Pallarés
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Hontangas
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
| | - Isabel Conde
- Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, València, Spain
| | - Tomasso Di Maira
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
| | - Salvador Peiró
- Health Services Research Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO Public Health), València, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO Public Health), València, Spain
| | - F. Xavier López-Labrador
- Virology Laboratory, Joint Units in Genomics and Health and Infection and Health, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO Public Health) / Universitat de València, València, Spain
- CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Marina Berenguer
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
- Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, València, Spain
- Department of Medicine, Universitat de València, València, Spain
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14
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Prevalence of HCV infection in a health area of Madrid (Spain): The first step towards microelimination. Enferm Infecc Microbiol Clin 2019; 38:317-322. [PMID: 31818498 DOI: 10.1016/j.eimc.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously diagnosed but not treated. METHODS Participants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay and determination of viraemia. RESULTS Of the 7,991 participants, 36.2% presented a positive HCV risk questionnaire. 4,717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe. CONCLUSION We found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.
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15
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Crespo J, Albillos A, Buti M, Calleja JL, García Samaniego J, Hernández Guerra M, Serrano T, Turnes J, Acín E, Berenguer J, Berenguer M, Colom J, Fernández I, Fernández Rodríguez C, Forns X, García F, Grandados R, Lazarus JV, Molero JM, Molina E, Pérez Escanilla F, Pineda JA, Rodríguez M, Romero M, Roncero C, Saiz de la Hoya P, Sánchez Antolín G. Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH). REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:862-873. [PMID: 31657609 DOI: 10.17235/reed.2019.6700/2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitis C virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1) Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of microelimination strategies in vulnerable populations; 2) Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3) Simplification of patient treatment and improvement of care circuits; 4) Health policy measures, and, finally, 5) Establishment of HCV elimination indicators.
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Affiliation(s)
- Javier Crespo
- Servicio Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, 39002
| | | | - María Buti
- Servicio de Hepatología, Hospital Universitario Vall d´Hebron
| | | | | | | | | | - Juan Turnes
- Servicio de Digestivo, Hospital Universitario de Pontevedra
| | | | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón. Ciberehd. Instituto de Salud Carlos III. Madrid
| | | | | | | | | | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, IDIBAPS
| | - Federico García
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio
| | | | | | | | - Esther Molina
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago
| | | | - Juan A Pineda
- Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias
| | - Manuel Romero
- Servicio Digestivo, Hospital Universitario Virgen del Rocío
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16
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Crespo J, Albillos A, Buti M, Calleja JL, Garcia-Samaniego J, Hernández-Guerra M, Serrano T, Turnes J, Acín E, Berenguer J, Berenguer M, Colom J, Fernández I, Fernández Rodríguez C, Forns X, García F, Granados R, Lazarus J, Molero JM, Molina E, Pérez Escanilla F, Pineda JA, Rodríguez M, Romero M, Roncero C, Saiz de la Hoya P, Sánchez Antolín G. Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH). ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.gastre.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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17
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Crespo J, Albillos A, Buti M, Calleja JL, García-Samaniego J, Hernández-Guerra M, Serrano T, Turnes J, Acín E, Berenguer J, Berenguer M, Colom J, Fernández I, Fernández Rodríguez C, Forns X, García F, Rafael Granados, Lazarus JV, Molero JM, Molina E, Pérez Escanilla F, Pineda JA, Rodríguez M, Romero M, Roncero C, Saiz de la Hoya P, Sánchez Antolín G. Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH). GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:579-592. [PMID: 31594683 DOI: 10.1016/j.gastrohep.2019.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
Abstract
The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitisC virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1)Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of micro-elimination strategies in vulnerable populations; 2)Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3)Simplification of patient treatment and improvement of care circuits; 4)Health policy measures, and, finally, 5)Establishment of HCV elimination indicators.
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Affiliation(s)
- Javier Crespo
- Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, Facultad de Medicina, UNICAN, Santander, España.
| | - Agustín Albillos
- Servicio de Digestivo, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Madrid, España
| | - María Buti
- Servicio de Hepatología, Hospital Universitario Vall d'Hebron y Ciberehd del Instituto Carlos III, Barcelona, España
| | - José Luis Calleja
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Facultad de Medicina, Universidad Autónoma, Madrid, España
| | | | | | - Trinidad Serrano
- Hospital Universitario Lozano Blesa, ISS Aragón, Zaragoza, España
| | - Juan Turnes
- Servicio de Digestivo, Hospital Universitario de Pontevedra, Pontevedra, España
| | - Enrique Acín
- Área de Salud Pública, Subdirección General de Sanidad Penitenciaria, Secretaría General de II.PP. Ministerio del Interior, Madrid, España
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, España
| | - Marina Berenguer
- Servicio de Digestivo, Hospital La Fe, Universidad de Valencia, Valencia y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) del Instituto Carlos III, Barcelona, España
| | - Joan Colom
- Dirección del Programa de Prevención, Control y Atención al VIH, las ITS y las Hepatitis Víricas, Subdirección general de Drogodependencias, Agencia de Salud Pública de Cataluña, Barcelona, España
| | - Inmaculada Fernández
- Servicio de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España
| | - Conrado Fernández Rodríguez
- Unidad de Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Comité científico de la SEPD, Alcorcón, Madrid, España
| | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, IDIBAPS y CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Federico García
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Instituto de Investigación Ibs Granada, Grupo de estudio de hepatitis de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEHEP-SEIMC), Granada, España
| | - Rafael Granados
- Hospital Universitario de Gran Canarias Dr. Negrín, Las Palmas de Gran Canaria, España
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | | | - Esther Molina
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Fernando Pérez Escanilla
- Centro de Salud San Juan de Salamanca, Facultad de Medicina, USAL, Representante de SEMG, Salamanca, España
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Grupo para el Estudio de las Hepatitis Víricas (GEHEP) de la SEIMC, Sevilla, España
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias, Oviedo, España
| | - Manuel Romero
- Servicio Digestivo, Hospital Universitario Virgen del Rocío, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Carlos Roncero
- Servicio de Psiquiatría, Complejo Asistencial Universitario de Salamanca, Instituto de Biomedicina de Salamanca, Universidad de Salamanca, Salamanca, España
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18
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Mar J, Ibarrondo O, Martínez-Baz I, Juanbeltz R, San Miguel R, Casado I, Arrospide A, Castilla J. Economic evaluation of a population strategy for the treatment of chronic hepatitis C with direct-acting antivirals. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 110:621-628. [PMID: 30032627 DOI: 10.17235/reed.2018.5605/2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The high initial cost of antivirals against hepatitis C prompted development of the "Strategic Plan for Tackling Chronic Hepatitis C in the Spanish National Health System". The objective of this study was the economic evaluation of the first two years of its application in Navarre, Spain. The change in the natural history of hepatitis C produced by the sustained virological response (SVR) was compared to an alternative without treatment and modeled with patient-level data. By means of a discrete events simulation model, the cost-effectiveness and the budget impact analysis of the treatment program were measured from the perspective of the Navarre Health Service. Of 656 patients treated, 98% had SVR. The average cost of the treatments was 18,743 euros per patient. The incremental cost-effectiveness ratio (ICER) with discount was 5,346 euros per quality-adjusted life years, which became more efficient as the stage of fibrosis increased until it reached levels of dominance in stage 4 fibrosis. The associated costs for chronic liver disease decreased as the benefit of the treatment was expressed. The implementation of the Strategic Plan is cost-effective, with an ICER well below the threshold, since the cost of treatment is largely compensated by savings in long-term health expenditure. The budgetary impact foresees a net saving from the third year on. The two key parameters were the decrease in the price of the treatment and the SVR in nearly 100% of the patients.
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Affiliation(s)
- Javier Mar
- Unidad Gestión Sanitaria, OSI Alto Deba, España
| | | | | | | | - Ramón San Miguel
- Departamento of Farmacia,, Complejo Hospitalario de Navarra - IdiSNA, , España
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, España
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Juanbeltz R, Pérez-García A, Aguinaga A, Martínez-Baz I, Casado I, Burgui C, Goñi-Esarte S, Repáraz J, Zozaya JM, San Miguel R, Ezpeleta C, Castilla J, EIPT-VHC Study Group. Progress in the elimination of hepatitis C virus infection: A population-based cohort study in Spain. PLoS One 2018; 13:e0208554. [PMID: 30513107 PMCID: PMC6279228 DOI: 10.1371/journal.pone.0208554] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/18/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain. METHODS Using electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period. RESULTS At the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950-1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels. CONCLUSIONS The prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary.
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Affiliation(s)
- Regina Juanbeltz
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
| | - Alejandra Pérez-García
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Aitziber Aguinaga
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
| | - Cristina Burgui
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
- Department of Pharmacy, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Silvia Goñi-Esarte
- Department of Gastroenterology and Hepatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús Repáraz
- Department of Internal Medicine, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - José Manuel Zozaya
- Department of Gastroenterology and Hepatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ramón San Miguel
- Department of Pharmacy, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Carmen Ezpeleta
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
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Abstract
PURPOSE The aim was to estimate seroprevalence and prevalence of hepatitis C virus (HCV) infection in a small health area of the Valencian Community, Spain. PATIENTS AND METHODS This is a descriptive cross-sectional study aimed at estimation of HCV infection prevalence in the whole adult population (25-70 years old), that is, a pilot study for an eventual population-based screening program. RESULTS A total of 5849 participants aged 25-70 years (51% male) were invited to participate by regular mail. Overall, 143 letters were returned owing to errors in the addresses. Of 5706 participants, 2637 (46.2%) participated in the study. Rapid test of anti-HCV antibody detection was positive in 30 cases (HCV seroprevalence 1.14%, 95% confidence intervals: 0.73-1.55%). Of those, seven were not aware of their condition. Participants who had a positive result in the rapid test of anti-HCV detection were given a confirmatory test by enzyme immune assay, and all had a positive result. RNA-HCV determination by quantitative PCR in positive anti-HCV patients showed positive viremia in 13 (43.3%) cases, of which five were not aware of the disease. Of the 17 patients who had negative viremia, two were unaware of their HCV status, one was a carrier of anti-HCV and was already aware of his condition, and 14 had been previously treated with satisfactory results. Regarding fibrosis, of the seven patients who were unaware of HCV infection, none of them had significant fibrosis. Moreover, 26 (86.7%) anti-HCV positive patients were reported to have one or more risk factors for HCV infection. CONCLUSION HCV screening strategies applied to the general population are good means to diagnose and treat patients who are not aware of their infection, avoiding new transmissions as well as disease progression.
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Berenguer J. Eliminación del virus de la hepatitis C en España: un reto pendiente. Enferm Infecc Microbiol Clin 2018; 36:323-324. [DOI: 10.1016/j.eimc.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/03/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022]
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