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Calleja JL, Espin J, Kaushik A, Hernandez-Guerra M, Blissett R, Yehoshua A, Igloi-Nagy A. The Efficiency of Increased HCV Testing and Treatment Strategies in Spain to Achieve Elimination Goals. PHARMACOECONOMICS - OPEN 2024; 8:221-233. [PMID: 38100074 PMCID: PMC10884368 DOI: 10.1007/s41669-023-00458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND In 2015, Spain launched a national eradication strategy for hepatitis C virus (HCV), resulting in the highest treatment rate in Europe and substantial reductions in HCV prevalence. However, to achieve the goal of HCV elimination, it is necessary to scale-up the diagnosis, treatment, and management of HCV infection. OBJECTIVE Our aim was to assess the prevalence, incidence, and cost effectiveness of scaling-up compared with status quo scenarios. METHODS A compartmental dynamic transmission model was developed comprising of a cascade of care and a liver progression module. Cost and quality-of-life inputs were sourced from the literature. Key outcomes were the prevalence and incidence of HCV and the incremental cost per quality-adjusted life-year (QALY) and per life-year (LY). Outcomes for a hypothetical elimination strategy were compared with the status quo. RESULTS The base-case analysis found that scaling-up testing and treatment reduced both the prevalence and incidence of HCV over time, resulting in incremental costs per QALY and LY of €13,291 and €12,285 respectively, compared with the status quo. The main drivers of the cost-effectiveness results included cost of diagnosis, cost of treatment, proportion of people who are unaware, percentage of population who inject drugs, and calibration parameters related to HCV infection prevalence. CONCLUSIONS This analysis demonstrated that scaling-up testing and treatment with direct-acting antivirals may be an efficient strategy for reducing the incidence and prevalence of HCV and may help achieve HCV elimination goals in Spain.
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Affiliation(s)
- Jose Luis Calleja
- Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jaime Espin
- Escuela Andaluza de Salud Pública, Granada, Spain
| | | | | | | | - Alon Yehoshua
- Formerly of Gilead Sciences, Inc., Foster City, CA, USA
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Aguilar R, Cruz A, Jiménez A, Almuedo A, Saumell CR, Lopez MG, Gasch O, Falcó G, Jiménez-Lozano A, Martínez-Perez A, Sanchez-Collado C, Tedesco A, López MC, Pinazo MJ, Leonel T, Bisoffi Z, Färnert A, Dobaño C, Requena-Méndez A. Evaluation of the accuracy of a multi-infection screening test based on a multiplex immunoassay targeting imported diseases common in migrant populations. Travel Med Infect Dis 2024; 57:102681. [PMID: 38141899 DOI: 10.1016/j.tmaid.2023.102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND We aimed to evaluate the performance of a novel multiplex serological assay, able to simultaneously detect IgG of six infections, as a screening tool for imported diseases in migrants. METHODS Six panels of 40 (n = 240) anonymized serum samples with confirmed infections were used as positive controls to assess the multiplex assay's sensitivity. One panel of 40 sera from non-infected subjects was used to estimate the seropositivity cutoffs, and 32 non-infected sera were used as negative controls to estimate each serology's sensitivity and specificity. The multi-infection screening test was validated in a prospective cohort of 48 migrants from endemic areas. The sensitivity of the Luminex assay was calculated as the proportion of positive results over all positive samples identified by reference tests. The specificity was calculated using 32 negative samples. Uncertainty was quantified with 95 % confidence intervals using receiver operating characteristic analyses. RESULTS The sensitivity/specificity were 100 %/100 % for HIV (gp41 antigen), 97.5 %/100 % for Hepatitis B virus (HBV-core antigen), 100 %/100 % for Hepatitis C virus (HCV-core antigen), 92.5 %/90.6 % for strongyloidiasis [31-kDa recombinant antigen (NIE)], 97.5 %/100 % for schistosomiasis (combined serpin Schistosoma mansoni and S.haematobium antigens) and 95 %/90.6 % for Chagas disease [combined Trypanosoma cruzi kinetoplastid membrane protein-11 (KMP11) and paraflagellar rod proteins 2 (PFR2) antigens]. In the migrant cohort, antibody response to the combination of the T.cruzi antigens correctly identified 100 % individuals, whereas HBV-core antigen correctly identified 91.7 % and Strongyloides-NIE antigen 86.4 %. CONCLUSIONS We developed a new, robust and accurate 8-plex Luminex assay that could facilitate the implementation of screening programmes targeting migrant populations.
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Affiliation(s)
- Ruth Aguilar
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 08036, Barcelona, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 08036, Barcelona, Spain
| | - Alfons Jiménez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 08036, Barcelona, Spain; Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Alex Almuedo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 08036, Barcelona, Spain
| | - Carme Roca Saumell
- Centre d'Atenció Primaria El Clot, Institut Català de la Salut (ICS), Carrer Concilio de Trento 25, 08018, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Carrer Casanova, 143, 08036, Barcelona, Spain
| | - Marina Gigante Lopez
- Centre d'Atenció Primaria Center Numància, Institut Català de la Salut (ICS), Carrer Numància 23, 08029, Barcelona, Spain
| | - Oriol Gasch
- Infectious Diseases Department, Hospital Universitari Parc Taulí. Institut d'Investigació i Innovació Parc Taulí. Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell-Barcelona, Spain
| | - Gemma Falcó
- Centre d'Atenció Primaria Sant Miquel, Institut Català de la Salut (ICS), Carrer Francesc Macià i Llussà, 154, 08401, Granollers-Barcelona, Spain
| | - Ana Jiménez-Lozano
- Centre d'Atenció Primaria Adrià 5A Marc Aureli, Institut Català de la Salut (ICS), Carrer Vallmajor, 34, 08021, Barcelona, Spain
| | - Angela Martínez-Perez
- Centre d'Atenció Primaria Casanova. Consorci d'Atenció Primària de Salut de l'Eixample (CAPSBE) Casanova. Carrer Rosselló 161, 08036, Barcelona, Spain
| | - Consol Sanchez-Collado
- Centre d'Atenció Primaria Torelló, Institut Català de la Salut (ICS), Avenida Pompeu Fabra, 8, 08570, Torelló-Barcelona, Spain
| | - Andrea Tedesco
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy
| | - Manuel Carlos López
- Spanish National Research Council (IPBLN-CSIC), Avenida del Conocimiento 17, Parque Tecnológico de Ciencias de la Salud, 18016, Granada, Spain
| | - María Jesús Pinazo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 08036, Barcelona, Spain; Biomedical Research Networking Center (CIBER) of Infectious Diseases, Carlos III Health Institute (CIBERINFEC, ISCIII), Carrer Melchor Fernández Almagro, 3, 28029, Madrid, Spain; Drugs for Neglected Diseases Iniciative (DNDi), Switzerland
| | - Thais Leonel
- Liver Unit, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Biomedical Research Networking Center of Hepatic and Digestive Diseases (CIBEREHD), Carrer Villarroel, 170, 08036, Barcelona, Spain
| | - Zeno Bisoffi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar di Valpolicella, Italy
| | - Anna Färnert
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 17177, Solna-Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Solnavägen 1, 17177, Solna-Stockholm, Sweden
| | - Carlota Dobaño
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 08036, Barcelona, Spain; Biomedical Research Networking Center (CIBER) of Infectious Diseases, Carlos III Health Institute (CIBERINFEC, ISCIII), Carrer Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Carrer Roselló 132, 08036, Barcelona, Spain; Biomedical Research Networking Center (CIBER) of Infectious Diseases, Carlos III Health Institute (CIBERINFEC, ISCIII), Carrer Melchor Fernández Almagro, 3, 28029, Madrid, Spain; Department of Medicine Solna, Karolinska Institutet, Solnavägen 1, 17177, Solna-Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Solnavägen 1, 17177, Solna-Stockholm, Sweden.
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3
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Reyes-Urueña J, Costell-González F, Egea-Cortés L, Ouaarab H, Saludes V, Buti M, Majó I Roca X, Colom J, Gómez I Prat J, Casabona J, Martro E. Implementation of the HepC link test-and-treat community strategy targeting Pakistani migrants with hepatitis C living in Catalonia (Spain) compared with the current practice of the Catalan health system: budget impact analysis. BMJ Open 2023; 13:e068460. [PMID: 37604632 PMCID: PMC10445371 DOI: 10.1136/bmjopen-2022-068460] [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: 10/06/2022] [Accepted: 07/23/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To perform a budget impact analysis of the HepClink test-and-treat strategy in which community health agents offer hepatitis C virus (HCV) testing, diagnosis and treatment to the Pakistani population living in Catalonia compared with the current practice of the Catalan health system (without targeted screening programmes). METHODS We estimated the population of adult Pakistani migrants registered at the primary care centres in Catalonia by means of the Information System for the Development of Research in Primary Care (n=37 972 in 2019, Barcelona health area). This cohort was followed for a time period of 10 years after HCV diagnosis (2019-2028). The statistical significance of the differences observed in the anti-HCV positivity rate between screened and non-screened was confirmed (α=0.05). The budget impact was calculated from the perspective of the Catalan Department of Health. Sensitivity analyses included different levels of participation in HepClink: pessimistic, optimistic and maximum. RESULTS The HepClink scenario screened a higher percentage of individuals (69.8%) compared with the current scenario of HCV care (39.7%). Viraemia was lower in the HepClink scenario compared with the current scenario (1.7% vs 2.5%, respectively). The budget impact of the HepClink scenario was €884 244.42 in 10 years. CONCLUSIONS Scaling up the HepClink strategy to the whole Catalan territory infers a high budget impact for the Department of Health and allows increasing the detection of viraemia (+17.8%) among Pakistani migrants ≥18 years. To achieve a sustainable elimination of HCV by improving screening and treatment rates, there is room for improvement at two levels. First, taking advantage of the fact that 68.08% of the Pakistani population had visited their primary care physicians to reinforce targeted screening in primary care. Second, to use HepClink at the community level to reach individuals with reluctance to use healthcare services.
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Affiliation(s)
- Juliana Reyes-Urueña
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Francisco Costell-González
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Laia Egea-Cortés
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Hakima Ouaarab
- Unitat de Salut Internacional Vall Hebrón-Drassanes, Hospital Universitario Vall Hebrón, Barcelona, Spain
| | - Veronica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Maria Buti
- Servicio de Hepatología, Hospital Universitario Vall Hebrón, Barcelona, Spain
| | - Xavier Majó I Roca
- 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 Gómez I Prat
- Unitat de Salut Internacional Vall Hebrón-Drassanes, Hospital Universitario Vall Hebrón, Barcelona, Spain
| | - Jordi Casabona
- Centre for Epidemiological Studies on STD/HIV/SIDA of Catalonia, Public Health Agency of Catalonia, Badalona, Spain
| | - Elisa Martro
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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4
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Dopico E, Rodriguez-Frias F, Ubillos I, Rando-Segura A, Garcia-Cehic D, Gregori J, Rando-Matos Y, Solsona L, Niubó J, Esteban JI, Costa J, Martínez MJ, Quer J. Prevalence of Hepatitis C Virus Infection, Genotypes and Subtypes in Migrants from Pakistan in Barcelona, Spain. Infect Drug Resist 2022; 15:4637-4644. [PMID: 36003985 PMCID: PMC9394658 DOI: 10.2147/idr.s367715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hepatitis C virus (HCV) is a major cause of chronic liver infection with 71 million people infected worldwide. Pakistan has the second highest prevalence of HCV infection and more than half (52%) of Pakistani living in Spain reside in Barcelona. The aim of this study was to analyse the seroprevalence and viraemic rate and determine the genotypes and subtypes of HCV among Pakistanis living in the southern metropolitan area of Barcelona. Methods We included all Pakistani patients seeking primary healthcare in the southern metropolitan area of Barcelona from August 2011 to July 2014. Serum samples were screened for HCV antibodies. HCV viral load was determined by reverse transcription polymerase chain reaction and genotypes and subtypes were performed using Versant HCV Genotype and/or deep-sequencing. Screening for hepatitis B virus (HBV) was also carried out. Results Among 5877 Pakistani patients, 565 (9.61%) were screened for anti-HCV antibodies, with 68 (12.04%) being positive. The viral load was determined in 65, with 31 presenting active infection and the viraemic rate was 47.69% (95% confidence interval 36.02-59.62). HCV genotyping and subtyping were performed in 24 individuals. Most infections corresponded to HCV genotype 3 (91.67%), and high resolution HCV subtyping was performed in 18 samples, 16 of which presented subtype 3a. One subject presented HBV coinfection with undetectable HBV DNA. During the study period, we identified a possible case of HCV vertical transmission followed by spontaneous viraemia clearance in a chronically infected mother with a C/T IL28B genetic polymorphism. Conclusion These results suggest that general HCV screening protocols in patients from high prevalence countries, such as Pakistan, would be helpful to identify and treat active HCV infections. This could avoid further transmission and contribute to building targeted health policies for micro-elimination of HCV infection in specific communities.
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Affiliation(s)
- Eva Dopico
- Microbiology Department, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Rodriguez-Frias
- Biochemistry Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Itziar Ubillos
- Laboratory Clínic Territorial Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | - Ariadna Rando-Segura
- Biochemistry Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Damir Garcia-Cehic
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Diseases-Viral Hepatitis, Liver Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Josep Gregori
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Diseases-Viral Hepatitis, Liver Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Yolanda Rando-Matos
- Equip d'Atenció Primària Florida Nord, Gerència d'Àmbit d'Atenció Primària Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Luis Solsona
- Equip d'Atenció Primària Florida Nord, Gerència d'Àmbit d'Atenció Primària Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jordi Niubó
- Microbiology Department, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Ignacio Esteban
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Diseases-Viral Hepatitis, Liver Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Josep Costa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Microbiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miguel J Martínez
- Microbiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Josep Quer
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.,Liver Diseases-Viral Hepatitis, Liver Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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5
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Martró E, Ouaarab H, Saludes V, Buti M, Treviño B, Roade L, Egea-Cortés L, Reyes-Ureña J, Not A, Majó X, Colom J, Gómez I Prat J. Pilot hepatitis C micro-elimination strategy in Pakistani migrants in Catalonia through a community intervention. Liver Int 2022; 42:1751-1761. [PMID: 35635535 DOI: 10.1111/liv.15327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/13/2022] [Accepted: 05/26/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Pakistani migrants in Catalonia, Spain, could have high hepatitis C virus (HCV) prevalence. The aims of the HepClink study were (i) to implement and assess the quality of a micro-elimination strategy based on a community intervention and (ii) to obtain data from primary care (PC) registries as a baseline comparator. METHODS The community intervention targeted Pakistani adults and consisted of education, screening and simplified access to treatment. Quality indicators were calculated (effectiveness, impact and acceptability). The testing rate, the prevalence of HCV antibodies and HCV-RNA were compared with those observed in the Pakistani population accessing PC in the previous year. RESULTS A total of 505 participants were recruited through the community intervention (64.6% men, median 37 years) vs those accessing PC (N = 25 455, 70.9% men, median 38 years). Among study participants, 35.1% did not know about HCV and 9.7% had been previously tested. The testing rate in the community intervention was 99.4% vs 50.7% in PC. Prevalence was 4.6% vs 7.1% (p = .008) for HCV antibodies and 1.4% (3/6 new diagnoses) vs 2.4% (p = .183) for HCV-RNA. Among the six viremic patients, three began treatment within the intervention and two through the usual circuit and all completed the full course. CONCLUSIONS This novel community intervention was well accepted and effective at reaching a Pakistani migrant population with a low-level knowledge of HCV and largely not tested before. The observed prevalence and the high unawareness of their HCV status justify a targeted screening in this group both in the community and in PC.
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Affiliation(s)
- Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Hakima Ouaarab
- Community & Public Health Team (ESPIC), Drassanes Vall d'Hebron Centre for International Health and Infectious Diseases, Barcelona, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Buti
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER en Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Begoña Treviño
- Drassanes Vall d'Hebron Centre for International Health and Infectious Diseases, Barcelona, Spain
| | - Luisa Roade
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laia Egea-Cortés
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona (Barcelona), Spain
| | - Juliana Reyes-Ureña
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona (Barcelona), Spain
| | - Anna Not
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), 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), (PCAVIHV), 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), (PCAVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Jordi Gómez I Prat
- Community & Public Health Team (ESPIC), Drassanes Vall d'Hebron Centre for International Health and Infectious Diseases, Barcelona, Spain
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6
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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: 6] [Impact Index Per Article: 2.0] [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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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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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 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). REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:862-873. [PMID: 31657609 DOI: 10.17235/reed.2019.6700/2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [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
| | | | - Jeffrey Lazarus
- Barcelona Institute for Global Health (ISGlobal). Hospital Clínic
| | | | - 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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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: 0.8] [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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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: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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11
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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: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [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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Hepatitis C virus infection in Spain: Challenges in the track to elimination. Enferm Infecc Microbiol Clin 2019; 37:219-221. [DOI: 10.1016/j.eimc.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 01/08/2023]
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13
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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. 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: 13] [Impact Index Per Article: 2.2] [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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