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Roussos S, Bagos C, Angelopoulos T, Chaikalis S, Cholongitas E, Savvanis S, Papadopoulos N, Kapatais A, Chounta A, Ioannidou P, Deutsch M, Manolakopoulos S, Sevastianos V, Papageorgiou MV, Vlachogiannakos I, Mela M, Elefsiniotis I, Vrakas S, Karagiannakis D, Pliarchopoulou F, Psichogiou M, Paraskevis D, Vickerman P, Malliori M, Kalamitsis G, Papatheodoridis G, Hatzakis A, Sypsa V. Incidence of primary hepatitis C infection among people who inject drugs during 2012-2020 in Athens, Greece. J Viral Hepat 2024. [PMID: 38742938 DOI: 10.1111/jvh.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/15/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
One of the World Health Organization's targets for the 2030 viral hepatitis elimination strategy is to reduce new hepatitis C (HCV) infections. In Athens, Greece, people who inject drugs (PWID) have a high HCV prevalence, with increasing trends since the 2000s. This analysis aims to assess primary HCV incidence among PWID during 2012-2020. Two community-based interventions were implemented in 2012-2013 and 2018-2020 with repeated sero-behavioural surveys in each period. Participants enrolled in multiple surveys were identified through linkage. To assess trends in HCV transmission, three indicators were estimated: (i) anti-HCV prevalence among 'new' injectors (those injecting ≤2 years), (ii) indirect HCV incidence among 'new' injectors, assuming infection occurred at the midpoint between initiating injection and the first positive test, and (iii) HCV incidence from repeat participants. There were 431 and 125 'new' injectors, respectively, in 2012-2013 and 2018-2020. Αnti-HCV prevalence [95% CI] declined from 53.6% [48.8%, 58.3%] in 2012-2013 to 40.0% [31.3, 49.1%] in 2018-2020 (25.4% reduction, p = .007). The indirect estimate [95% CI] of HCV incidence among 'new' injectors decreased from 56.1 [49.3, 63.8] to 39.0/100 person-years (PYs) [29.6, 51.5] (30.5% reduction, p = .020). HCV incidence [95% CI] based on seroconversions in repeat participants (16/63 in 2012-2013 and 9/55 in 2018-2020) declined from 64.6 [39.6105.4] to 13.8/100 PYs [7.2, 26.5], respectively (78.6% reduction, p < .001). Primary HCV incidence remains high among PWID in Athens. Consistent implementation of combined interventions, including high-coverage harm reduction programs and initiatives tailored to increase access to HCV treatment, is essential to sustain the declining trends documented during 2012-2020.
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Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodoros Angelopoulos
- Gastroenterology Department, General Hospital of Athens Korgialeneio - Mpenakeio Hellenic Red Cross, Athens, Greece
| | - Savvas Chaikalis
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Savvanis
- Department of Internal Medicine, General Hospital of Athens "Elpis", Athens, Greece
| | - Nikolaos Papadopoulos
- 2nd Department of Internal Medicine, 401 General Army Hospital of Athens, Athens, Greece
| | - Andreas Kapatais
- 1st Department of Internal Medicine, Western Attica General Hospital "Agia Varvara", Athens, Greece
| | - Athina Chounta
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Panagiota Ioannidou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Melani Deutsch
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | - Spilios Manolakopoulos
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | | | - Maria-Vasiliki Papageorgiou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Ioannis Vlachogiannakos
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Maria Mela
- Department of Gastroenterology, Evangelismos General Hospital, Athens, Greece
| | - Ioannis Elefsiniotis
- Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Vrakas
- Department of Gastroenterology, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Dimitrios Karagiannakis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Fani Pliarchopoulou
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Meni Malliori
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Georgios Papatheodoridis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Rao Guthi V, Sujith Kumar D, Kumar S, Kondagunta N, Raj S, Goel S, Ojah P. Hypertension treatment cascade among men and women of reproductive age group in India: analysis of National Family Health Survey-5 (2019-2021). THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100271. [PMID: 38404520 PMCID: PMC10884964 DOI: 10.1016/j.lansea.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/12/2023] [Accepted: 08/18/2023] [Indexed: 02/27/2024]
Abstract
Background Only a proportion of adults with hypertension are diagnosed and receive recommended prescriptions despite the availability of inexpensive and efficacious treatment. We aimed to estimate the prevalence of different stages of hypertension treatment cascade among the reproductive age groups in India at the national and state levels. We also identified the predictors of different stages of the hypertension treatment cascade. Methods We used the nationally representative data from National Family Health Survey (NFHS)-5. We included all the males (15-54 years) and females aged 15-49. Socio-demographic factors, anthropometric measurements, habits, comorbid conditions, and healthcare access stratified the stages of the hypertension treatment cascade among hypertensives. We used multinomial logistic regression to identify the determinants of the treatment cascade levels. Findings We had data from 1,267,786 individuals. The national prevalence of hypertension was 18.3% (95% CI: 18.1%-18.4%). Men (21.6%, 95% CI: 21.5%-21.7%) were found to have a higher prevalence as compared to women (14.8%, 95% CI: 14.7%-14.9%). Among hypertensive individuals, 70.5% (95% CI: 70.3%-70.7%) had ever received a BP measurement ("screened"), 34.3% (95% CI: 34.1%-34.5%) had been diagnosed prior to the survey ("aware"), 13.7% (95% CI: 13.5%-13.8%) reported taking a prescribed anti-hypertensive drug ("under treatment"), and 7.8% (95% CI: 7.7%-7.9%) had their BP under control ("controlled"). Males, illiterates, poor, never married, residents of rural areas, smokers/tobacco users, and alcoholic users were less likely to be in any of the treatment cascades. Interpretation The prevalence of hypertension in India is high. The "Rule of half" of hypertension does not apply to India as the proportion of people screened, aware of their hypertension status, treated, and controlled are lower than 50% at each stage. Program managers must improve access to hypertension diagnosis and treatment, especially among men in rural areas and populations with lower household wealth. Funding None.
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Affiliation(s)
- Visweswara Rao Guthi
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - D.S. Sujith Kumar
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, AIIMS, Bhopal, India
| | - Nagaraj Kondagunta
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - Sonika Raj
- Public Health Masters Program, School of Medicine, University of Limerick, Ireland
| | - Sonu Goel
- Public Health Masters Program, School of Medicine, University of Limerick, Ireland
| | - Pratyashee Ojah
- Biostatistics and Demography, International Institute for Population Sciences, Mumbai, India
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Hepatitis B, C and human immunodeficiency virus knowledge among the general greek population: results from the Hprolipsis nationwide survey. BMC Public Health 2022; 22:2026. [PMCID: PMC9637311 DOI: 10.1186/s12889-022-14353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/09/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Background
Although several studies on hepatitis B (HBV), C (HCV) and human immunodeficiency virus (HIV) infection have been conducted in Greece, little is known on the knowledge level of the Greek population towards these three infections. Our aim was to assess the knowledge level of the adult Greek general population about the HBV, HCV and HIV.
Methods
Data were derived from the first general population health survey, Hprolipsis. The sample was selected by multistage stratified random sampling. A standardized questionnaire was administered by trained interviewers during home visits. A knowledge score was constructed based on responses to 17 per infection selected items and categorized in three levels; high (12–17 correct replies) medium (6–11) and low (0–5). Among 8,341 eligible individuals, 6,006 were recruited (response rate: 72%) and 5,878 adults (≥ 18 years) were included in the analysis. The statistical analysis accounted for the study design.
Results
Only 30.4%, 21.6%, and 29.6% of the participants had a high overall knowledge level of HBV, HCV and HIV, respectively. These low percentages were mainly attributed to the high levels of misconception about transmission modes (65.9%, 67.2%, and 67.9%, respectively). Results showed that increasing age and living out of the big metropolitan cities were associated with decreased odds of having higher knowledge. Female gender, higher education level, higher monthly family income, higher medical risk score, history of testing and being born in Greece or Cyprus, were associated with increased odds of having higher knowledge.
Conclusions
There are significant knowledge gaps in the Greek general population regarding modes of transmission, preventive measures and treatment availability for HBV, HCV and HIV. There is an urgent need for large scale but also localized awareness activities targeted to less privileged populations, to fill the gaps in knowledge and increase population engagement in preventive measures.
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van Oorschot E, Koc ÖM, Oude Lashof AML, van Loo IHM, Ackens R, Posthouwer D, Koek GH. Cascade of care among hepatitis B patients in Maastricht, the Netherlands, 1996 to 2018. J Virus Erad 2022; 8:100075. [PMID: 35784678 PMCID: PMC9241047 DOI: 10.1016/j.jve.2022.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background & aims Methods Results Conclusions
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Affiliation(s)
- Eva van Oorschot
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Corresponding author. Maastricht UMC+P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Özgür M. Koc
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Astrid ML. Oude Lashof
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Maastricht University Medical Centre, the Netherlands
| | - Inge HM. van Loo
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands
| | - Robin Ackens
- Department of Integrated Care, Maastricht University Medical Centre, the Netherlands
| | - Dirk Posthouwer
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Maastricht University Medical Centre, the Netherlands
| | - Ger H. Koek
- School of Nutrition and Translational Research in Metabolism (Nutrim), Maastricht University, the Netherlands
- Department of Visceral and Transplantation Surgery, Klinikum, RWTH, Aachen, Germany
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Maastricht University, the Netherlands
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Prevalence of Hepatitis B Serum Markers in Young Military Recruits in Greece: A Comparison Study between 2005 and 2019 Cohorts. LIVERS 2021. [DOI: 10.3390/livers1040018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The prevalence of hepatitis B varies (HBV) among countries. Although an overall reduction has been described in Greece, data are limited. Methods: We reviewed the HBsAg/anti-HBc/anti-HBs seroprevalence among military recruits and compared data between 2005 and 2019. The study included 2001 (group 1) and 1629 (group 2) male recruits in 2019 and 2005, respectively. Age and descent were recorded. Results: The prevalence of HBsAg, anti-HBc and anti-HBs positivity in group1 vs. group 2 was estimated as: 0.2%, 1.3% and 67% vs. 0.4%, 1.6% and 62%, respectively. Only anti-HBs positivity achieved a statistically significant difference between the two groups (p = 0.007). HBsAg and anti-HBc were more frequently positive in non-Greeks than in Greeks (9/237 (4%) vs. 2/3393 (0.06%), p < 0.001), (26/237 (11%) vs. 26/3393 (0.8%), p < 0.001 respectively), while anti-HBs was more frequently positive in Greeks than in non-Greeks (84/164 (51%) vs. 1461/2213 (66%), p < 0.001). Conclusions: Our data suggest a further reduction in HBV prevalence in Greece about 20 years after the adoption of the National HBV Immunization Program, with Greek participants experiencing a more effective HBV Immunization Program than non-Greeks.
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French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long. BMC Infect Dis 2020; 20:759. [PMID: 33059617 PMCID: PMC7559725 DOI: 10.1186/s12879-020-05478-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). METHODS The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. RESULTS Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). CONCLUSIONS This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.
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Sevastianos VA, Geladari CV, Voulgaris TA, Georgantoni AI, Andreadis EA. A surveillance study of the prevalence of Hepatitis B, C, and D markers among hospitalized patients at an Internal Medicine Department of a Greek Hospital. Eur J Intern Med 2020; 79:142-144. [PMID: 32448768 DOI: 10.1016/j.ejim.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | - Anna I Georgantoni
- 4th Department of Internal Medicine, Ipsilandou 45-47, 10676 Athens, Greece
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Koc ÖM, Kremer C, Hens N, Bielen R, Busschots D, Van Damme P, Robaeys G. Early detection of chronic hepatitis B and risk factor assessment in Turkish migrants, Middle Limburg, Belgium. PLoS One 2020; 15:e0234740. [PMID: 32716949 PMCID: PMC7384618 DOI: 10.1371/journal.pone.0234740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
Background Turkey is an intermediate hepatitis B virus (HBV) endemic country. However, prevalence among Turkish migrants in Belgium is unknown, especially in those born in Belgium with a foreign-born parent, i.e. second-generation migrants (SGM). Aims To evaluate the prevalence of HBV infection and associated risk factors in Turkish first-generation migrants (FGM), i.e. foreign-born, and SGM. Methods Between September 2017 and May 2019, free outreach testing for hepatitis B surface antigen (HBsAg), hepatitis B core antibodies (anti-HBc), and antibodies against HBsAg was offered to Turkish migrants in Middle-Limburg, Belgium. Face-to-face questionnaire assessed HBV risk factors. HBsAg positive patients were referred and followed up. Turkish SGM were stratified into birth cohort born before and after 1987, since those born after 1987 should be covered by the universal infant vaccination program. Results A total of 1,081/1,113 (97.1%) Turkish did go for HBV testing. Twenty-six (2.4%) were HBsAg positive; 11/26 were unaware of their status and 10/11 were successfully referred. HBsAg prevalence was 3.0% in FGM and 1.5% in SGM, p = .070. Only one out of seven HBsAg positive SGM was born after 1987. In the multiple generalized estimating equations model, the most important risk factors for anti-HBc positivity were male gender (p = .021), older age (p < .001), FGM (p < .001), low educational level of the mother (p = .003), HBV infected mother (p = .008), HBV infected siblings (p = .002), HBV infected other family member (p = .004), gynaecological examination in Turkey or unsafe male circumcision (p = .032) and dental treatment in Turkey (p = .049). Conclusion Outreach testing was well-accepted and referral to specialist care was generally successful. National HBV screening should be implemented in the Turkish FGM population and might be considered in SGM not covered by primary prevention strategies.
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Affiliation(s)
- Özgür M. Koc
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Cécile Kremer
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-Biostat), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-Biostat), Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Rob Bielen
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Dana Busschots
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pierre Van Damme
- Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, Antwerp University, Wilrijk, Antwerp, Belgium
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium
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Touloumi G, Karakosta A, Sypsa V, Petraki I, Anagnostou O, Terzidis A, Voudouri NM, Gavana M, Vantarakis A, Rachiotis G, Kantzanou M, Rosenberg T, Papatheodoridis G, Hatzakis A. Design and Development of a Viral Hepatitis and HIV Infection Screening Program (Hprolipsis) for the General, Greek Roma, and Migrant Populations of Greece: Protocol for Three Cross-Sectional Health Examination Surveys. JMIR Res Protoc 2020; 9:e13578. [PMID: 32004142 PMCID: PMC7055811 DOI: 10.2196/13578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023] Open
Abstract
Background Although infectious diseases are globally on the decline, they remain a major global public health problem. Among them, the hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV infection are of primary interest. Valid prevalence data on these infections are sparse in Greece, especially for vulnerable populations. Objective This study aimed to present the design and methods of Hprolipsis, an integrated viral hepatitis and HIV screening program administered to adults (≥18 years) from the general, Greek Roma, and migrant populations. Its aims were to estimate the prevalence of HBV, HCV, and HIV; assess infectious disease knowledge level; design, implement, and assess population-specific awareness actions; and offer individual counseling and referral when indicated and HBV vaccination to susceptible Roma and migrants. Methods Multistage, stratified, random sampling based on the 2011 Census was applied to select the general population sample, and nonprobability multistage quota sampling was used for Roma and migrant sample selection. Trained personnel made home (general population) or community (Roma and migrants) visits. Collected blood samples were tested for Hepatitis B surface Antigen, Hepatitis B core Antibody, Hepatitis B surface Antibody, Hepatitis C Antibody, and HIV 1,2 Antibody. The surveys were conducted during May 2013 and June 2016. To estimate an HCV prevalence of 1.5% with 0.3 precision, the required general population sample size was estimated to be 6000. As migrants constitute 10% of the whole Greek population, the migrant sample size was set to 600. A feasible sample size of 500 Greek Roma was set. Results In total, 6006 individuals from the general population (response rate 72%), 534 Greek Roma, and 612 migrants were recruited. Blood test results are available for 4245 individuals from the general population, 523 Roma, and 537 migrants. Conclusions Hprolipsis is the first nationwide survey on HBV, HCV, and HIV. Its results will enhance our understanding of the health needs and disease burden of these diseases in the 3 studied populations. Its implementation provided useful recommendations for future studies, particularly in vulnerable populations. International Registered Report Identifier (IRRID) DERR1-10.2196/13578
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Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Petraki
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga Anagnostou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Agis Terzidis
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Niki Maria Voudouri
- Programs of Development, Social Support, and Medical Cooperation (PRAKSIS), Athens, Greece
| | | | - Magda Gavana
- Department of Primary Health Care, General Practice, and Health Services Research, Medical School of Aristotle University, Thessaloniki, Greece
| | - Apostolos Vantarakis
- Environmental Microbiology Unit of Public Health, Medical School, University of Patras, Patra, Greece
| | - George Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larisa, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofilos Rosenberg
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Koustenis KR, Anagnostou O, Kranidioti H, Vasileiadi S, Antonakaki P, Koutli E, Pantsas P, Deutsch M, Manolakopoulos S. Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting. Ann Gastroenterol 2020; 33:195-201. [PMID: 32127741 PMCID: PMC7049240 DOI: 10.20524/aog.2020.0449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
Background Direct-acting antivirals (DAAs) offer high cure rates in people who inject drugs (PWID) with hepatitis C virus (HCV) infection. There are concerns regarding lower response rates among PWID in real life. We evaluated the outcome of DAA therapy in PWID in a real-world setting and the factors that affect it. Methods We performed a retrospective analysis of 174 PWID with chronic hepatitis C who started DAAs in a Greek liver clinic in collaboration with an addiction program. Patients who did not return for reassessment were considered as lost to follow up (LTFU). A logistic regression model was used to assess factors associated with a sustained virological response 12 weeks after treatment completion (SVR12) and LTFU. Results Patients' mean age was 48±9.2 years and 91/174 (52.3%) were attending opioid substitution treatment programs. Overall, 144/174 (82.8%) patients completed therapy and presented for SVR12 testing, 8/174 (4.6%) did not complete treatment and 22/174 (12.6%) were LTFU. Overall SVR12 was 79.9% (139/174). For those with an available SVR12 test the response rate reached 96.5% (139/144). Regression analysis did not indicate any significant association between patient characteristics and SVR12. Age <45 years and genotype 3 were independent predictors of LTFU. Parallel use was found to have a trend towards LTFU. Conclusions HCV treatment by hepatologists and addiction specialists is feasible, effective and safe in a real-world setting. However, as 12% of patients appear to be LTFU, more emphasis should be placed on interventions guaranteeing follow up for SVR testing and general care.
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Affiliation(s)
- Kanellos Rafail Koustenis
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Olga Anagnostou
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Hariklia Kranidioti
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Sofia Vasileiadi
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Pinelopi Antonakaki
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Evangelia Koutli
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Paris Pantsas
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Melanie Deutsch
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Spilios Manolakopoulos
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos).,Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (Spilios Manolakopoulos), Athens, Greece
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11
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Tentolouris A, Eleftheriadou I, Athanasakis K, Kyriopoulos J, Tsilimigras DI, Grigoropoulou P, Doupis J, Tentolouris N. Prevalence of diabetes mellitus as well as cardiac and other main comorbidities in a representative sample of the adult Greek population in comparison with the general population. Hellenic J Cardiol 2020; 61:15-22. [DOI: 10.1016/j.hjc.2018.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 01/02/2023] Open
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12
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'Distribution of Hepatitis C Virus genotypes in northern Greece in the last decade: descriptive analysis and clinical correlations'. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2019; 4:e5. [PMID: 31516719 PMCID: PMC6719250 DOI: 10.1017/gheg.2019.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 11/17/2022]
Abstract
Hepatitis C virus (HCV) represents a major public health problem, while the identification of a HCV genotype is clinically very important for therapy prescription. The aim of the present study was to determine the HCV genotype distribution patients from northern Greece with HCV RNA positive viral load and to identify whether there is a shift in this distribution, during 2009–2017. The study was performed on 915 HCV positive patients and according to the results, genotype 3 was the most prevalent genotype (Ν = 395, 43.2%) followed by genotype 1 (Ν = 361, 39.5%). Regarding the gender of the patients, genotype 1 was mostly detected in women. Moreover, genotype 1 was associated with higher viral loads, while genotype 3 was most frequently detected in patients with a history of intravenous drug use. In conclusion, our results show that genotype 3 is the most prevalent genotype in Greece during the last decade as opposed to older epidemiological studies, likely due to intravenous drug use becoming the major source of infection.
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13
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Papatheodoridis GV, Goulis J, Sypsa V, Lionis C, Manolakopoulos S, Elefsiniotis I, Anagnostou O, Tsoulas C, Hatzakis A, Dalekos GN. Aiming towards hepatitis C virus elimination in Greece. Ann Gastroenterol 2019; 32:321-329. [PMID: 31263353 PMCID: PMC6595935 DOI: 10.20524/aog.2019.0375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
There are estimated to be 74,000-134,000 patients living with chronic hepatitis C in Greece, but only 20-30% of them are aware of their disease status. In July 2017, the Hellenic National Plan for Hepatitis C was announced in alignment with the World Health Organization goals for the eradication of hepatitis C virus (HCV) by the year 2030. This article discusses the epidemiology and current treatment of chronic hepatitis C in Greece. Additionally the authors propose actions on how to bring back to care diagnosed patients lost to follow up, optimize access to care for HCV-infected people who inject drugs, and increase HCV screening in the general population. The medical community in Greece can play a pivotal role in the implementation of the HCV National Plan and in the efforts to reach the goal of HCV elimination.
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Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (George V. Papatheodoridis)
| | - John Goulis
- 4 Department of Internal Medicine, Αristotle University of Thessaloniki Medical School (John Goulis)
| | - Vana Sypsa
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion-Crete (Christos Lionis)
| | - Spilios Manolakopoulos
- 2 Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens (Spilios Manolakopoulos)
| | - Ioannis Elefsiniotis
- Academic Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, Athens (Ioannis Elefsiniotis)
| | - Olga Anagnostou
- Greek Organisation Against Drugs (OKANA), Athens (Olga Anagnostou)
| | - Christos Tsoulas
- Medical Department, Gilead Sciences Hellas, Athens (Christos Tsoulas)
| | - Angelos Hatzakis
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa (George N. Dalekos), Greece
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14
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Papatheodoridis GV, Hatzakis A, Cholongitas E, Baptista-Leite R, Baskozos I, Chhatwal J, Colombo M, Cortez-Pinto H, Craxi A, Goldberg D, Gore C, Kautz A, Lazarus JV, Mendão L, Peck-Radosavljevic M, Razavi H, Schatz E, Tözün N, van Damme P, Wedemeyer H, Yazdanpanah Y, Zuure F, Manns MP. Hepatitis C: The beginning of the end-key elements for successful European and national strategies to eliminate HCV in Europe. J Viral Hepat 2018; 25 Suppl 1:6-17. [PMID: 29508946 DOI: 10.1111/jvh.12875] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 12/12/2022]
Abstract
Hepatitis C virus (HCV) infection is a major public health problem in the European Union (EU). An estimated 5.6 million Europeans are chronically infected with a wide range of variation in prevalence across European Union countries. Although HCV continues to spread as a largely "silent pandemic," its elimination is made possible through the availability of the new antiviral drugs and the implementation of prevention practices. On 17 February 2016, the Hepatitis B & C Public Policy Association held the first EU HCV Policy Summit in Brussels. This summit was an historic event as it was the first high-level conference focusing on the elimination of HCV at the European Union level. The meeting brought together the main stakeholders in the field of HCV: clinicians, patient advocacy groups, representatives of key institutions and regional bodies from across European Union; it served as a platform for one of the most significant disease elimination campaigns in Europe and culminated in the presentation of the HCV Elimination Manifesto, calling for the elimination of HCV in Europe by 2030. The launch of the Elimination Manifesto provides a starting point for action in order to make HCV and its elimination in Europe an explicit public health priority, to ensure that patients, civil society groups and other relevant stakeholders will be directly involved in developing and implementing HCV elimination strategies, to pay particular attention to the links between hepatitis C and social marginalization and to introduce a European Hepatitis Awareness Week.
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Affiliation(s)
- G V Papatheodoridis
- Medical School of National, Kapodistrian University of Athens, Athens, Greece
| | - A Hatzakis
- Medical School of National, Kapodistrian University of Athens, Athens, Greece
| | - E Cholongitas
- Medical School of National, Kapodistrian University of Athens, Athens, Greece
| | - R Baptista-Leite
- Institute of Health Sciences, Católica University of Portugal, Lisbon, Portugal.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - J Chhatwal
- Massachusetts General Hospital' s, Institute for Technology Assessment and Harvard Medical School, Boston, MA, USA
| | - M Colombo
- Clinical and Research Center Humanitas, Rozzano, Italy
| | - H Cortez-Pinto
- European Association for the Study of the Liver, Geneva, Switzerland.,Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal
| | - A Craxi
- University of Palermo, Palermo, Italy
| | - D Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - C Gore
- Hepatitis C Trust, World Hepatitis Alliance, London, UK
| | - A Kautz
- Leberhilfe Projekt gUG, Cologne, Germany
| | - J V Lazarus
- Barcelonai Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Mendão
- Portuguese Activist Group for HIV/AIDS Treatment, Lisbon, Portugal.,European AIDS Treatment Group, Brussels, Belgium
| | | | - H Razavi
- Center for Disease Analysis, Lafayette, CO, USA
| | - E Schatz
- Correlation Network, Amsterdam, The Netherlands
| | - N Tözün
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - P van Damme
- Antwerp University, Antwerp, Belgium.,Viral Hepatitis Prevention Board, Antwerp, Belgium
| | | | | | - F Zuure
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Manns
- Hannover Medical School, Hannover, Germany
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15
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Nayagam S, Sicuri E, Lemoine M, Easterbrook P, Conteh L, Hallett TB, Thursz M. Economic evaluations of HBV testing and treatment strategies and applicability to low and middle-income countries. BMC Infect Dis 2017; 17:692. [PMID: 29143675 PMCID: PMC5688395 DOI: 10.1186/s12879-017-2778-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Many people living with chronic HBV infection remain undiagnosed until later stages of disease. Increasing testing and treatment rates form part of the strategy to respond to the WHO goal of eliminating viral hepatitis as a public health threat by 2030. However, achieving these ambitious targets is dependent on finding effective and cost-effective methods of scale up strategies. The aim of this study was to undertake a narrative review of the literature on economic evaluations of testing and treatment for HBV infection, to help inform the development of the 2017 WHO Hepatitis Testing Guidelines. Methods We undertook a focussed literature review for economic evaluations on testing for HBV accompanied by antiviral treatment. The search was carried out in Pubmed and included only articles published after 2000 and written in English. We narratively synthesise the results and discuss the key drivers of cost-effectiveness and their applicability to low and middle-income countries (LMICs). Results Nine published studies were included in this review, only one of which was performed in a low or middle-income setting in West Africa. Eight studies were performed in high-income settings, seven among high risk groups and one among the general population. The studies were heterogeneous in many respects including the population and testing strategy under consideration, model structure and baselines parameters, willingness to pay thresholds and outcome measures used. However, most studies found HBV testing and treatment to be cost-effective, even at low HBsAg prevalence levels. Conclusions Currently economic evaluations of HBV testing and treatment strategies in LMICs is lacking, therefore limiting the ability to provide formal recommendations on the basis of cost-effectiveness alone. Further implementation research is needed in order to help guide national policy planning.
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Affiliation(s)
- Shevanthi Nayagam
- Division of Digestive Diseases, Imperial College, London, UK. .,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK.
| | - Elisa Sicuri
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Maud Lemoine
- Division of Digestive Diseases, Imperial College, London, UK
| | - Philippa Easterbrook
- Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland
| | - Lesong Conteh
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
| | - Mark Thursz
- Division of Digestive Diseases, Imperial College, London, UK
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16
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Adherence to follow-up and treatment recommendations in Greek and immigrant patients with chronic hepatitis B in Greece. Eur J Gastroenterol Hepatol 2017; 29:264-270. [PMID: 27922484 DOI: 10.1097/meg.0000000000000788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM Immigrants have multiple barriers to access to health care systems. We evaluated the adherence to follow-up and treatment recommendations of chronic hepatitis B virus (HBV) Greek and immigrant patients. METHODS In total, 1001 consecutive adult patients with chronic HBV infection who visited our clinics for the first time between 2002 and 2011 were included. All patients born outside Greece were considered immigrants. Diagnosis was considered to be complete if patients could be classified into HBeAg-positive chronic hepatitis B (CHB), inactive carriers, HBeAg-negative CHB, or decompensated cirrhosis. RESULTS Of the patients, 56% were Greeks and 44% were immigrants. Greeks visited our clinics at a significantly older mean age (50 vs. 35 years, P<0.001) and more frequently with advanced liver disease (11.4 vs. 6.4%, P=0.007). During the first year, Greeks more frequently had several tests and eventually a complete diagnosis (68 vs. 55%, P<0.001). Greeks were more frequently in the phase of HBeAg-negative CHB and less frequently in the phase of inactive carrier or HBeAg-positive CHB, but age was the main determinant for these differences in multivariate analysis. Treatment was initiated more frequently by Greeks than immigrants with treatment indications (86 vs. 65%, P<0.001). Only 30-33% of treated and 4-10% of untreated patients remained under follow-up at year 5, without significant differences between Greeks and immigrants. CONCLUSION Adherence to follow-up recommendations is rather poor for all chronic HBV patients. Immigrants are lost more frequently during the first year, but only small proportions of treated and particularly untreated Greek or immigrant patients remain under long-term follow-up.
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17
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Gountas I, Sypsa V, Papatheodoridis G, Souliotis G, Razavi H, Hatzakis A. Is elimination of HCV possible in a country with low diagnostic rate and moderate HCV prevalence?: The case of Greece. J Gastroenterol Hepatol 2017; 32:466-472. [PMID: 27403912 DOI: 10.1111/jgh.13485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The treatment of hepatitis C (HCV) with interferon (IFN)-free direct-acting antivirals (DAAs) is anticipated to change the future burden of disease. The aim of this study is to quantify the impact of IFN-free DAAs on HCV-related morbidity and mortality in Greece under different scenarios concerning treatment coverage and primary prevention, including the proposed by World Health Organization Global Hepatitis Strategy. METHODS A previously described model was used to project the future disease burden up to 2030 under scenarios, which includes treatment based on the combination of pegylated-IFN with ribavirin (base case) and scenarios using DAAs therapies. RESULTS Under the base case scenario, an increase in HCV-related morbidity and mortality is predicted in Greece (mortality in 2030: +23.6% compared with 2015). If DAAs are used with the same treatment coverage, the number of hepatocellular carcinoma cases and of liver related deaths are predicted to be lower by 4-7% compared with 2015. Under increased treatment coverage (from 2000 treated/year to approximately 5000/year in 2015-2020 and 2500/year subsequently), morbidity and mortality will decrease by 43-53% in 2030 compared with 2015. To achieve the WHO Global Hepatitis Strategy goals, a total number of 86 500 chronic hepatitis C patients will have to be treated during 2015-2030. CONCLUSIONS Elimination of HCV in Greece by 2030 necessitates great improvements in primary prevention, implementation of large screening programs and high treatment coverage.
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Affiliation(s)
- Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - George Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado, USA
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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18
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Geitona M, Kousoulakou H, Goulis I, Manolakopoulos S, Vasiliadis T, Christodoulou D, Gogos C, Dourakis S, George Koskinas I, Papadokostopoulou A, Lathouris A, Papatheodoridis G. Managing Hepatitis C Patients in Greece: A Budget Impact Analysis of Simeprevir plus Pegylated Interferon/Ribavirin Regimen at Early Stages of the Disease. Health (London) 2017. [DOI: 10.4236/health.2017.911109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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19
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Triantos C, Konstantakis C, Tselekouni P, Kalafateli M, Aggeletopoulou I, Manolakopoulos S. Epidemiology of hepatitis C in Greece. World J Gastroenterol 2016; 22:8094-8102. [PMID: 27688651 PMCID: PMC5037078 DOI: 10.3748/wjg.v22.i36.8094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/07/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C is a global health issue and constitutes a major cause of chronic liver disease worldwide. In this article, a comprehensive literature search was conducted for the prevalence of hepatitis C virus (HCV) infection in Greece, since data on the HCV prevalence, viremia and genotypes are important for developing strategies to manage or eliminate HCV infection. In addition, the pattern of HCV infection was analyzed according to the geographic region and the risk factors. These differences reflect not only distinct epidemiological characteristics among populations, but also differences on the strategy of data acquisition and quantification. Although there are not enough data, the estimation of the current prevalence of Hepatitis C in Greece ranges from 0.5% to 2%. The most important risk factors for HCV infection include blood product transfusion, intravenous drug use, chronic hemodialysis, organ transplantation, occupational exposure, sexual transmission, and vertical transmission. Because of lack of vaccine or effective post-exposure prophylaxis for HCV, the main focus of prevention is to recognize and control these risk factors. HCV infection in Greece is closely associated with the development of chronic liver disease, cirrhosis, and primary hepatocellular carcinoma. As far as the genotype distribution is concerned genotype 1 estimated to be 45%-47% and it constitutes the prevalent genotype in Greece, followed by genotype 3.
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Manolakopoulos S, Zacharakis G, Zissis M, Giannakopoulos V. Safety and efficacy of daclatasvir in the management of patients with chronic hepatitis C. Ann Gastroenterol 2016; 29:282-96. [PMID: 27366028 PMCID: PMC4923813 DOI: 10.20524/aog.2016.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/22/2016] [Indexed: 02/06/2023] Open
Abstract
Daclatasvir (Daklinza™), a new oral direct-acting antiviral, is an inhibitor of hepatitis C virus NS5A protein and has recently been approved in the United States, Europe and Japan in chronic hepatitis C. It shows potent pangenotypic activity and moderately high genetic barrier to resistance improving the sustained virological response (SVR) rates. In COMMAND phase 2 trials, daclatasvir demonstrated high SVR rates in HCV genotype 1-4 chronically infected patients treated with peginterferon-a (pegIFNα) plus ribavirin (RBV). Furthermore, it produced even higher response rates in all-oral combination with sofosbuvir, an interferon-free regimen, with or without ribavirin, in patients with advanced liver disease, HCV/HIV coinfection, liver transplantation in ALLY studies and other real-world studies. This narrative review provides information on the pharmacological properties, role, efficacy and safety of daclatasvir-containing regimens in chronic hepatitis C patients. Daclatasvir administered once-daily in combination with sofosbuvir is an effective 12-week treatment in adult patients with chronic hepatitis C and is generally safe and well tolerated.
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Affiliation(s)
- Spilios Manolakopoulos
- 2 Department of Internal Medicine, Hippocration General Hospital, Athens Greece (Spilios Manolakopoulos)
| | - George Zacharakis
- Endoscopy Unit, Limassol General Hospital and St George’s University of London Medical School at the University of Nicosia, Republic of Cyprus (George Zacharakis)
- Department of Internal Medicine, University Hospital, Prince Sattam Bin Abdulaziz University, Al Kharj, KSA (George Zacharakis)
| | - Miltiadis Zissis
- Medical Affairs Department, Bristol-Myers Squibb, Athens Greece (Miltiadis Zissis, Vassilis Giannakopoulos)
| | - Vassilis Giannakopoulos
- Medical Affairs Department, Bristol-Myers Squibb, Athens Greece (Miltiadis Zissis, Vassilis Giannakopoulos)
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Hill A, Gotham D, Cooke G, Bhagani S, Andrieux-Meyer I, Cohn J, Fortunak J. Analysis of minimum target prices for production of entecavir to treat hepatitis B in high- and low-income countries. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30484-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Saraswat V, Norris S, de Knegt RJ, Sanchez Avila JF, Sonderup M, Zuckerman E, Arkkila P, Stedman C, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Baatarkhuu O, Barclay K, Ben-Ari Z, Bergin C, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Chulanov V, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Vree M, Estes C, Flisiak R, Gadano AC, Gane E, Halota W, Hatzakis A, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Mossong J, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Puri P, Radke S, Rakhmanova A, Razavi H, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanduijav R, Schréter I, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Sokolov S, Souliotis K, Spearman CW, Staub T, Strebkova EA, Struck D, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuure FR, Silva MO, Sypsa V, Gower E. Historical epidemiology of hepatitis C virus (HCV) in select countries - volume 2. J Viral Hepat 2015; 22 Suppl 1:6-25. [PMID: 25560839 DOI: 10.1111/jvh.12350] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of liver related morbidity and mortality. In many countries, there is a lack of comprehensive epidemiological data that are crucial in implementing disease control measures as new treatment options become available. Published literature, unpublished data and expert consensus were used to determine key parameters, including prevalence, viremia, genotype and the number of patients diagnosed and treated. In this study of 15 countries, viremic prevalence ranged from 0.13% in the Netherlands to 2.91% in Russia. The largest viremic populations were in India (8 666 000 cases) and Russia (4 162 000 cases). In most countries, males had a higher rate of infections, likely due to higher rates of injection drug use (IDU). Estimates characterizing the infected population are critical to focus screening and treatment efforts as new therapeutic options become available.
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Affiliation(s)
- V Saraswat
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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