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Périllaud-Dubois C, Hachicha-Maalej N, Lepers C, Letamendia E, Teissier N, Cousien A, Sibiude J, Deuffic-Burban S, Vauloup-Fellous C, Picone O. Cost-effectiveness of screening and valacyclovir-based treatment strategies for first-trimester cytomegalovirus primary infection in pregnant women in France. Ultrasound Obstet Gynecol 2023; 62:573-584. [PMID: 37099516 DOI: 10.1002/uog.26226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To assess the effectiveness, cost and cost-effectiveness of four screening strategies for first-trimester (T1) cytomegalovirus (CMV) primary infection (PI) in pregnant women in France. METHODS In a simulated pregnant population of 800 000 (approximate number of pregnancies each year in France), using costs based on the year 2022, we compared four CMV maternal screening strategies: Strategy S1, no systematic screening (current public health recommendations in France); Strategy S2, screening of 25-50% of the pregnant population (current screening practice in France); Strategy S3, universal screening (current medical recommendations in France); Strategy S4, universal screening (as in Strategy S3) in conjunction with valacyclovir in case of T1 PI. Outcomes were total cost, effectiveness (number of congenital infections, number of diagnosed infections) and incremental cost-effectiveness ratio (ICER). Two ICERs were calculated, comparing Strategies S1, S2 and S3 in terms of euros (€) per additional diagnosis, and comparing Strategies S1 and S4 in € per avoided congenital infection. RESULTS Compared with Strategy S1, Strategy S3 enabled diagnosis of 536 more infected fetuses and Strategy S4 prevented 375 congenital infections. Strategy S1 was the least expensive strategy (€98.3m total lifetime cost), followed by Strategy S4 (€98.6m), Strategy S2 (€106.0m) and Strategy S3 (€118.9m). In the first analysis, Strategy S2 was dominated and Strategy S3 led to an additional €38 552 per additional in-utero diagnosis, compared with Strategy S1. In the second analysis, Strategy S4 led to an additional €893 per avoided congenital infection compared with Strategy S1, and was cost-saving compared with Strategy S2. CONCLUSIONS In France, current screening practice for CMV PI during pregnancy is no longer acceptable in terms of cost-effectiveness because this strategy was dominated by universal screening. Moreover, universal screening in conjunction with valacyclovir treatment would be cost-effective compared with current recommendations and is cost-saving compared with current practice. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Périllaud-Dubois
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, France
- Virology Laboratory, Sorbonne Université, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - N Hachicha-Maalej
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, France
| | - C Lepers
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, France
| | - E Letamendia
- Department of Neonatal Medicine, Université Paris-Saclay, Hôpital Antoine Béclère, AP-HP, DMU2 Santé des Femmes et des Nouveau-nés, Clamart, France
| | - N Teissier
- Department of Pediatric Otolaryngology, Robert Debré Hospital, AP-HP Nord, Paris, France
- Université de Paris, INSERM U1141 NeuroDiderot, Inserm, Paris, France
| | - A Cousien
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, France
| | - J Sibiude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, France
- Division of Obstetrics and Gynecology, Hôpital Louis Mourier, AP-HP Nord, Colombes, France
| | - S Deuffic-Burban
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, France
| | - C Vauloup-Fellous
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Virology Laboratory, Université Paris-Saclay, Hôpital Paul-Brousse, AP-HP, Villejuif, France
| | - O Picone
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, Paris, France
- Division of Obstetrics and Gynecology, Hôpital Louis Mourier, AP-HP Nord, Colombes, France
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Hedible GB, Louart S, Neboua D, Catala L, Anago G, Sawadogo AG, Kargougou GD, Meda B, Kolié JS, Hema A, Keita S, Niome M, Savadogo AS, Peters-Bokol L, Agbeci H, Zair Z, Lenaud S, Vignon M, Ouedraogo Yugbare S, Abarry H, Diakite AA, Diallo IS, Lamontagne F, Briand V, Dahourou DL, Cousien A, Ridde V, Leroy V. Evaluation of the routine implementation of pulse oximeters into integrated management of childhood illness (IMCI) guidelines at primary health care level in West Africa: the AIRE mixed-methods research protocol. BMC Health Serv Res 2022; 22:1579. [PMID: 36566173 PMCID: PMC9789366 DOI: 10.1186/s12913-022-08982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/16/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The AIRE operational project will evaluate the implementation of the routine Pulse Oximeter (PO) use in the integrated management of childhood illness (IMCI) strategy for children under-5 in primary health care centers (PHC) in West Africa. The introduction of PO should promote the accurate identification of hypoxemia (pulse blood oxygen saturation Sp02 < 90%) among all severe IMCI cases (respiratory and non-respiratory) to prompt their effective case management (oxygen, antibiotics and other required treatments) at hospital. We seek to understand how the routine use of PO integrated in IMCI outpatients works (or not), for whom, in what contexts and with what outcomes. METHODS The AIRE project is being implemented from 03/2020 to 12/2022 in 202 PHCs in four West African countries (Burkina Faso, Guinea, Mali, Niger) including 16 research PHCs (four per country). The research protocol will assess three complementary components using mixed quantitative and qualitative methods: a) context based on repeated cross-sectional surveys: baseline and aggregated monthly data from all PHCs on infrastructure, staffing, accessibility, equipment, PO use, severe cases and care; b) the process across PHCs by assessing acceptability, fidelity, implementation challenges and realistic evaluation, and c) individual outcomes in the research PHCs: all children under-5 attending IMCI clinics, eligible for PO use will be included with parental consent in a cross-sectional study. Among them, severe IMCI cases will be followed in a prospective cohort to assess their health status at 14 days. We will analyze pathways, patterns of care, and costs of care. DISCUSSION This research will identify challenges to the systematic implementation of PO in IMCI consultations, such as health workers practices, frequent turnover, quality of care, etc. Further research will be needed to fully address key questions such as the best time to introduce PO into the IMCI process, the best SpO2 threshold for deciding on hospital referral, and assessing the cost-effectiveness of PO use. The AIRE research will provide health policy makers in West Africa with sufficient evidence on the context, process and outcomes of using PO integrated into IMCI to promote scale-up in all PHCs. TRIAL REGISTRATION Trial registration number: PACTR202206525204526 retrospectively registered on 06/15/2022.
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Affiliation(s)
- Gildas Boris Hedible
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Sarah Louart
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal ,grid.500774.1IRD, CEPED, Paris, France ,grid.503422.20000 0001 2242 6780University of Lille, CLERSE - Centre Lillois d’Études et de Recherches Sociologiques et Économiques, Lille, France
| | - Désiré Neboua
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal
| | - Laura Catala
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Gildas Anago
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal
| | | | | | | | | | - Adama Hema
- Terre des hommes-Lausanne (Tdh), Ouagadougou, Burkina Faso
| | | | | | | | - Lucie Peters-Bokol
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Honorat Agbeci
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Zineb Zair
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | | | - Marine Vignon
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal
| | | | - Hannatou Abarry
- Ministère de la santé, des populations et des affaires sociales, Niamey, Niger
| | | | | | | | - Valérie Briand
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Inserm UMR 1219, IRD EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Désiré Lucien Dahourou
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France ,grid.433132.40000 0001 2165 6445Institut de Recherche en Sciences de la Santé/CNRST, Département Biomédical, Santé Publique, Ouagadougou, Burkina Faso
| | - Anthony Cousien
- grid.508487.60000 0004 7885 7602Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
| | | | - Valériane Leroy
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France ,grid.15781.3a0000 0001 0723 035XCenter for Epidemiology and Research in Population Health (CERPOP), UMR 1295, Inserm, University Paul Sabatier Toulouse 3, Toulouse, France
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Castry M, Cousien A, Champenois K, Supervie V, Velter A, Ghosn J, Yazdanpanah Y, Paltiel AD, Deuffic‐Burban S. Cost-effectiveness of hepatitis C virus test-and-treat and risk reduction strategies among men who have sex with men living with HIV in France. J Int AIDS Soc 2022; 25:e26035. [PMID: 36451286 PMCID: PMC9712801 DOI: 10.1002/jia2.26035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Studies suggest that hepatitis C virus (HCV) micro-elimination is feasible among men who have sex with men (MSM) living with human immunodeficiency virus (HIV), through treatment-as-prevention and interventions aimed at reducing risk behaviours. However, their economic impact is poorly understood. The aim of this study was to assess the cost-effectiveness of HCV screening and risk reduction strategies in France. METHODS A compartmental deterministic mathematical model was developed to describe HCV disease transmission and progression among MSM living with HIV in France. We evaluated different combinations of HCV screening frequency (every 12, 6 or 3 months) and risk reduction strategies (targeting only high-risk or all MSM) from 2021 onwards. The model simulated the number of HCV infections, life-expectancy (LYs), quality-adjusted life-expectancy (QALYs), lifetime costs and incremental cost-effectiveness ratio (ICER) over a lifetime horizon (leading to an end of the simulation in 2065). RESULTS All strategies increased QALYs, compared with current practices, that is yearly HCV screening, with no risk reduction. A behavioural intervention resulting in a 20% risk reduction in the high-risk group, together with yearly screening, was the least expensive strategy, and, therefore, cost-saving compared to current practices. The ICER per QALY gained for the strategy combining risk reduction for the high-risk group with 6-month HCV screening, compared to risk reduction with yearly screening, was €61,389. It also prevented 398 new HCV infections between 2021 and 2065, with a cost per infection averted of €37,790. All other strategies were dominated (more expensive and less effective than some other available alternative) or not cost-effective (ICER per QALY gained > €100,000). CONCLUSIONS In the French context, current HCV screening practices without risk reduction among MSM living with HIV cannot be justified on economic grounds. Risk reduction interventions targeted to high-risk individuals-alongside screening either once or twice a year-could be cost-effective depending on the policymaker's willingness-to-pay.
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Affiliation(s)
| | | | | | - Virginie Supervie
- Sorbonne UniversitéInsermInstitut Pierre Louis d’Épidémiologie et de Santé PubliqueParisFrance
| | | | - Jade Ghosn
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
| | - Yazdan Yazdanpanah
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
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Cousien A, Acquaviva E, Kernéis S, Yazdanpanah Y, Delorme R. Temporal Trends in Suicide Attempts Among Children in the Decade Before and During the COVID-19 Pandemic in Paris, France. JAMA Netw Open 2021; 4:e2128611. [PMID: 34618041 PMCID: PMC8498848 DOI: 10.1001/jamanetworkopen.2021.28611] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This cross-sectional study uses surveillance data to assess temporal trends in suicide attempts among children admitted to a pediatric emergency department in Paris, France, in the decade before and during the COVID-19 pandemic.
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Affiliation(s)
- Anthony Cousien
- Infection, Antimicrobials, Modeling, and Evolution Laboratory, French National Institute of Health and Medical Research, University of Paris, Paris, France
| | - Eric Acquaviva
- Department of Child and Adolescent Psychiatry, University of Paris, Robert Debré University Hospital, Assistance Publique–Hôpitaux de Paris, Paris France
| | - Solen Kernéis
- Infection, Antimicrobials, Modeling, and Evolution Laboratory, French National Institute of Health and Medical Research, University of Paris, Paris, France
- Infection Prevention and Control Team, Bichat-Claude Bernard University Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Yazdan Yazdanpanah
- Infection, Antimicrobials, Modeling, and Evolution Laboratory, French National Institute of Health and Medical Research, University of Paris, Paris, France
- Department of Infectious and Tropical Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Richard Delorme
- Department of Child and Adolescent Psychiatry, University of Paris, Robert Debré University Hospital, Assistance Publique–Hôpitaux de Paris, Paris France
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Castry M, Cousien A, Bellet J, Champenois K, Pialoux G, Yazdanpanah Y, Costagliola D, Grabar S, Deuffic-Burban S. Hepatitis C virus (HCV) incidence among men who have sex with men (MSM) living with HIV: results from the French Hospital Database on HIV (ANRS CO4-FHDH) cohort study, 2014 to 2017. ACTA ACUST UNITED AC 2021; 26. [PMID: 34558403 PMCID: PMC8462035 DOI: 10.2807/1560-7917.es.2021.26.38.2001321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BackgroundDespite the availability of highly effective direct-acting antivirals (DAAs) and the expected treatment as prevention (TasP) effect, transmission of hepatitis C virus (HCV) persists in men who have sex with men (MSM) who engage in high-risk sexual behaviours.AimWe aimed to estimate the incidence of primary HCV infection among MSM living with HIV in France when DAA was readily available.MethodsWe used data from a large French hospital cohort of persons living with HIV (ANRS CO4-FHDH) prospectively collected between 2014 and 2017. HCV incidence rates were calculated using person-time methods for HCV-negative MSM at inclusion who had serological follow-up from 1 January 2014 to 31 December 2017. Sensitivity analyses were performed by varying the main assumptions to assess their impact on the results.ResultsOf 14,273 MSM living with HIV who were initially HCV-seronegative, 330 acquired HCV during follow-up over 45,866 person-years (py), resulting in an overall estimated incidence rate of 0.72/100 py (95% CI: 0.65-0.80). HCV incidence significantly decreased from 0.98/100 py (95% CI: 0.81-1.19) in 2014 to 0.45/100 py (95% CI: 0.35-0.59) in 2017 (54% decrease; 95% CI: 36-67). This trend was confirmed by most of the sensitivity analyses.ConclusionThe primary incidence of HCV was halved for MSM living with HIV between 2014 and 2017. This decrease may be related to unrestricted DAA availability in France for individuals living with HIV. Further interventions, including risk reduction, are needed to reach HCV micro-elimination in MSM living with HIV.
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Affiliation(s)
| | | | - Jonathan Bellet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | | | - Gilles Pialoux
- Sorbonne Université, Department of Infectious Diseases, APHP, Hôpital Tenon, Paris, France
| | - Yazdan Yazdanpanah
- Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France.,Université de Paris, INSERM, IAME, Paris, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Sophie Grabar
- Assistance Publique-Hôpitaux de Paris (AP-HP), Département de Santé Publique, Hôpital Saint-Antoine, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
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- The members of the ANRS CO4-FHDH cohort are acknowledged at the end of the article
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Castry M, Cousien A, Supervie V, Velter A, Ghosn J, Paltiel AD, Yazdanpanah Y, Deuffic-Burban S. Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach. Gut 2021; 70:1561-1569. [PMID: 33109688 DOI: 10.1136/gutjnl-2020-321744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Since the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related behaviours. Early HCV diagnosis and treatment, and behavioural risk-reduction, may be effective to eliminate HCV among MSM living with HIV. DESIGN We developed a deterministic dynamic compartmental model to simulate the impact of test-and-treat and risk-reduction strategies on HCV epidemic (particularly on incidence and prevalence) among MSM living with HIV in France. We accounted for HIV and HCV cascades of care, HCV natural history and heterogeneity in HCV risk behaviours. The model was calibrated to primary HCV incidence observed between 2014 and 2017 among MSM living with HIV in care (ANRS CO4-French hospital database on HIV (FHDH)). RESULTS With current French practices (annual HCV screening and immediate treatment), total HCV incidence would fall by 70%, from 0.82/100 person-years in 2015 to 0.24/100 person-years in 2030. It would decrease to 0.19/100 person-years in 2030 with more frequent screening and to 0.19 (0.12)/100 person-years in 2030 with a 20% (50%) risk-reduction. When combining screening every 3 months with a 50% risk-reduction, HCV incidence would be 0.11/100 person-years in 2030, allowing to get close to the WHO target (90% reduction from 2015 to 2030). Similarly, HCV prevalence would decrease from 2.79% in 2015 to 0.48% in 2030 (vs 0.71% with current practices). CONCLUSION Combining test-and-treat and risk-reduction strategies could have a marked impact on the HCV epidemic, paving the way to HCV elimination among MSM living with HIV.
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Affiliation(s)
- Mathieu Castry
- Université de Paris, Inserm, IAME, F-75006 Paris, France
| | | | - Virginie Supervie
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Annie Velter
- Department of Infectious Diseases, Santé Publique France, French national public health agency, Saint-Maurice, France
| | - Jade Ghosn
- Université de Paris, Inserm, IAME, F-75006 Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, F-75018 Paris, France
| | - A David Paltiel
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Yazdan Yazdanpanah
- Université de Paris, Inserm, IAME, F-75006 Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, F-75018 Paris, France
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Husain M, Rachline A, Cousien A, Rolland S, Ferre V, Wicky-Thisse M, Descamps D, Yazdanpanah Y, Charpentier C, Pasquet-Cadre A. Impact de la pandémie de COVID-19 sur les populations sans domicile fixe : résultats d’une cohorte fermée rétrospective (mars–mai 2020). Infect Dis Now 2021. [PMCID: PMC8327534 DOI: 10.1016/j.idnow.2021.06.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction Les populations de sans domicile fixe ont un taux de mortalité supérieur à celui de la population générale. Ceci est en partie en lien avec des maladies chroniques non suivis, des problèmes d’addiction ainsi qu’une exposition plus forte aux maladies transmissibles, en particulier respiratoires. Nous avons réalisé une étude pour évaluer les taux d’attaque, d’hospitalisation et de mortalité liés à l’infection par le SARS-CoV-2 dans une population de résidents de centres d’hébergement pour sans-abri et du personnel à leur contact. Matériels et méthodes Une étude sérologique rétrospective a été réalisée sur l’ensemble des résidents et des membres du personnel de trois centres d’hébergement pour sans-abri entre mars et mai 2020 : 2 centres de lits halte soins santé (LHSS) et un dortoir de femmes. Nous avons inclus tous les adultes présents dans les centres d’hébergement ou décédés d’une infection avérée par le SARS-CoV-2. Les IgG anti-SARS-CoV-2 étaient détectés par le test ELISA « SARS-CoV-2 IgG Architect (Abbott) ». Un cas confirmé de SARS-CoV-2 était défini comme tout participant présentant une PCR ou une sérologie positive. Des sérologies de contrôle ont été prélevées quatre mois après la première sérologie positive. Résultats Nous avons inclus 100 résidents et 83 membres du personnel. Le taux de SARS-CoV-2 confirmé par PCR ou sérologie était de 72/100 (72,0 %) pour les résidents et de 17/83 (20,5 %) pour le personnel. Le taux d’hospitalisation chez les résidents était de 17/72 (25 %) et le taux de décès de 4/72 (5,6 %). Toutes les hospitalisations sauf une et tous les décès sont survenus chez des résidents des LHSS. Trente-quatre sur 68 (50 %) des résidents des LHSS présentaient au moins deux facteurs de risque de forme grave d’infection par le SARS-CoV-2. Les femmes hébergées dans le dortoir étaient plus jeunes, présentaient moins de comorbidité, avaient le taux d’attaque le plus élevé (90,6 %) et une morbidité-mortalité quasi nulle. Cinquante-deux sur 80 (63,4 %) des personnes ayant une première sérologie positive ont eu une sérologie de contrôle à 4 mois de la première sérologie et 8 mois environ de leur infection. Parmi eux, 44 (84,6 %) avaient conservé des sérologies positives. Conclusion Le taux d’attaque du SARS-CoV-2 était extrêmement élevé chez les résidents des centres d’hébergement pour sans-abri par rapport à la population générale. Le risque d’infection grave par le SARS-CoV-2 était fortement associé à la présence de comorbidités à un plus jeune âge. Cette population à risqué doit être considérée comme prioritaire dans les campagnes de vaccination dans l’accès aux logements individuels pour les plus vulnérables.
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Husain M, Rachline A, Cousien A, Rolland S, Rouzaud C, Ferre VM, Gomez MV, Le Teurnier M, Wicky-Thisse M, Descamps D, Yazdanpanah Y, Charpentier C, Pasquet-Cadre A. Impact of the COVID-19 pandemic on the homeless: results from a retrospective closed cohort in France (March-May 2020). Clin Microbiol Infect 2021; 27:1520.e1-1520.e5. [PMID: 34111590 PMCID: PMC8182982 DOI: 10.1016/j.cmi.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hospitalization and fatality rates in residents of homeless shelters run by Samusocial of Paris. Methods We conducted a retrospective serological study between July and August 2020 on all residents and staff members of three homeless shelters run by Samusocial of Paris: two centres providing healthcare accommodation (HCA) and one a women's dormitory. We included all adults present in the shelters or who died of a proven SARS-CoV-2 infection during the first wave (March–May). SARS-CoV-2 antibodies were detected in serum samples using the SARS-CoV-2 IgG Architect (Abbott) test. Any participant with a positive PCR or serology was defined as a confirmed SARS-CoV-2 case. Results We included 100 residents and 83 staff members. The confirmed SARS-CoV-2 rate by PCR or serology was 72/100 (72.0%) for residents and 17/83 (20.5%) for staff members. Women accommodated in the dormitory had the highest infection rate (90.6%). The hospitalization rate in residents was 17/72 (23.6%) and the death rate 4/72 (5.6%). All hospitalizations and deaths occurred among HCA residents. Among the residents of HCA shelters, 34/68 (50%) presented at least two comorbidity factors associated with being at high risk for severe SARS-CoV-2 infection. Conclusion The SARS-CoV-2 infection rate was high in residents of these homeless shelters (10.6% seroprevalence in the Île-de-France region during the first wave). Severe SARS-CoV-2 infection was highly associated with the prevalence of comorbidities. This population should be considered as a priority in vaccination campaigns and in access to individual housing units when at risk.
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Affiliation(s)
- Maya Husain
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France.
| | - Anne Rachline
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | | | - Simon Rolland
- INSERM CIC 1417 Cochin Pasteur, AP-HP, Hôpital Cochin, 75014, Paris, France; Department of Infectious and Tropical Diseases, Cavale Blanche University Hospital, 29200, Brest, France
| | - Claire Rouzaud
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Necker enfants malades, F-75015, Paris, France; Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Valentine Marie Ferre
- Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | | | - Maï Le Teurnier
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | | | - Diane Descamps
- Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | - Yazdan Yazdanpanah
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | - Charlotte Charpentier
- Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
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9
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Kardaś-Słoma L, Yazdanpanah Y, Perozziello A, Zahar JR, Lescure FX, Cousien A, Lucet JC. Hand hygiene improvement or antibiotic restriction to control the household transmission of extended-spectrum β-lactamase-producing Escherichia coli: a mathematical modelling study. Antimicrob Resist Infect Control 2020; 9:139. [PMID: 32825851 PMCID: PMC7441222 DOI: 10.1186/s13756-020-00803-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background The best strategy to control ESBL-producing Escherichia coli (ESBL-EC) spread in the community is lacking. Methods We developed an individual-based transmission model to evaluate the impact of hand hygiene (HH) improvement and reduction in antibiotic use on the within-household transmission of ESBL-EC. We used data from the literature and incorporated key elements of ESBL-EC transmission such as the frequency and nature of contacts among household members, antibiotic use in the community and hand hygiene behaviour. We introduced in a household a single ESBL-EC colonised person and simulated the transmission dynamics of ESBL-EC over a one-year time horizon. Results The probability of ESBL-EC transmission depended on the household composition and the profile of the initial carrier. In the two-person household, the probability of ESBL-EC transmission was 5.3% (95% CI 5.0–5.6) or 6.6% (6.3–6.9) when the index person was a woman or a man, respectively. In a four-person household, the probability of transmission varied from 61.4% (60.9–62.0) to 68.8% (68.3–69.3) and was the highest when the index patient was the baby. Improving HH by 50% reduced the probability of transmission by 33–62%. Antibiotic restriction by 50% reduced the transmission by 2–6%. Conclusions The transmission of ESBL-EC is frequent in households and especially those with a baby. Antibiotic reduction had little impact on ESBL-EC. Improvement of hygiene in the community could help prevent transmission of ESBL-EC.
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Affiliation(s)
- Lidia Kardaś-Słoma
- INSERM, Infection, Antimicrobials, Modelisation, Evolution (IAME), UMR 1137, F-75018, Paris, France. .,University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France. .,AP-HP, Bichat-Calude Bernard Hospital, F-75018, Paris, France.
| | - Yazdan Yazdanpanah
- INSERM, Infection, Antimicrobials, Modelisation, Evolution (IAME), UMR 1137, F-75018, Paris, France.,University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.,AP-HP, Bichat-Claude Bernard Hospital, Infectious and Tropical Diseases Unit, F-75018, Paris, France
| | - Anne Perozziello
- INSERM, Infection, Antimicrobials, Modelisation, Evolution (IAME), UMR 1137, F-75018, Paris, France.,University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
| | - Jean-Ralph Zahar
- INSERM, Infection, Antimicrobials, Modelisation, Evolution (IAME), UMR 1137, F-75018, Paris, France.,AP-HP, Avicenne University Hospital, Infection Control Unit, F-93000, Bobigny, France
| | - François-Xavier Lescure
- INSERM, Infection, Antimicrobials, Modelisation, Evolution (IAME), UMR 1137, F-75018, Paris, France.,University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.,AP-HP, Bichat-Claude Bernard Hospital, Infectious and Tropical Diseases Unit, F-75018, Paris, France
| | - Anthony Cousien
- INSERM, Infection, Antimicrobials, Modelisation, Evolution (IAME), UMR 1137, F-75018, Paris, France.,University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
| | - Jean-Christophe Lucet
- INSERM, Infection, Antimicrobials, Modelisation, Evolution (IAME), UMR 1137, F-75018, Paris, France.,University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.,AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
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10
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Cousien A, Ledien J, Souv K, Leang R, Huy R, Fontenille D, Ly S, Duong V, Dussart P, Piola P, Cauchemez S, Tarantola A. Predicting Dengue Outbreaks in Cambodia. Emerg Infect Dis 2020; 25:2281-2283. [PMID: 31742509 PMCID: PMC6874239 DOI: 10.3201/eid2512.181193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In Cambodia, dengue outbreaks occur each rainy season (May–October) but vary in magnitude. Using national surveillance data, we designed a tool that can predict 90% of the variance in peak magnitude by April, when typically <10% of dengue cases have been reported. This prediction may help hospitals anticipate excess patients.
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11
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Castellan G, Cousien A, Tran VC. Non-parametric adaptive estimation of order 1 Sobol indices in stochastic models, with an application to Epidemiology. Electron J Stat 2020. [DOI: 10.1214/19-ejs1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Cousien A, Abel S, Monthieux A, Andronico A, Calmont I, Cervantes M, Césaire R, Gallian P, de Lamballerie X, Laouénan C, Najioullah F, Pierre-François S, Pircher M, Salje H, ten Bosch QA, Cabié A, Cauchemez S. Assessing Zika Virus Transmission Within Households During an Outbreak in Martinique, 2015-2016. Am J Epidemiol 2019; 188:1389-1396. [PMID: 30995296 PMCID: PMC6601520 DOI: 10.1093/aje/kwz091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/12/2022] Open
Abstract
Since 2015, Zika virus (ZIKV) has caused large epidemics in the Americas. Households are natural targets for control interventions, but quantification of the contribution of household transmission to overall spread is needed to guide policy. We developed a modeling framework to evaluate this contribution and key epidemic features of the ZIKV epidemic in Martinique in 2015-2016 from the joint analysis of a household transmission study (n = 68 households), a study among symptomatic pregnant women (n = 281), and seroprevalence surveys of blood donors (n = 457). We estimated that the probability of mosquito-mediated within-household transmission (from an infected member to a susceptible one) was 21% (95% credible interval (CrI): 5, 51), and the overall probability of infection from outside the household (i.e., in the community) was 39% (95% CrI: 27, 50). Overall, 50% (95% CrI: 43, 58) of the population was infected, with 22% (95% CrI: 5, 46) of infections acquired in households and 40% (95% CrI: 23, 56) being asymptomatic. The probability of presenting with Zika-like symptoms due to another cause was 16% (95% CrI: 10, 23). This study characterized the contribution of household transmission in ZIKV epidemics, demonstrating the benefits of integrating multiple data sets to gain more insight into epidemic dynamics.
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Affiliation(s)
- Anthony Cousien
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - Sylvie Abel
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Alice Monthieux
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Alessio Andronico
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - Isabelle Calmont
- Institut National de la Santé et de la Recherche Médicale Centre d’Investigation Clinique 1424, Fort-de-France, Martinique
| | - Minerva Cervantes
- Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Raymond Césaire
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Pierre Gallian
- Unité Mixte de Recherche Émergence des Pathologies Virales, Aix-Marseille University, Institut de Recherche pour le Développement 190, Institut National de la Santé et de la Recherche Médicale 1207, École des Hautes Études en Santé Publique, Instituts Hospitalo-Universitaires Méditerranée Infection, Marseille, France
- Etablissement Français du Sang Provence Alpes Côte d’Azur et Corse, Marseille, France
| | - Xavier de Lamballerie
- Unité Mixte de Recherche Émergence des Pathologies Virales, Aix-Marseille University, Institut de Recherche pour le Développement 190, Institut National de la Santé et de la Recherche Médicale 1207, École des Hautes Études en Santé Publique, Instituts Hospitalo-Universitaires Méditerranée Infection, Marseille, France
| | - Cédric Laouénan
- Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Fatiha Najioullah
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Sandrine Pierre-François
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Mathilde Pircher
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Henrik Salje
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - Quirine A ten Bosch
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - André Cabié
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
- Institut National de la Santé et de la Recherche Médicale Centre d’Investigation Clinique 1424, Fort-de-France, Martinique
- Equipe d’Accueil 4537, Université des Antilles, Fort-de-France, Martinique
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
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Ledien J, Souv K, Leang R, Huy R, Cousien A, Peas M, Froehlich Y, Duboz R, Ong S, Duong V, Buchy P, Dussart P, Tarantola A. An algorithm applied to national surveillance data for the early detection of major dengue outbreaks in Cambodia. PLoS One 2019; 14:e0212003. [PMID: 30730979 PMCID: PMC6366704 DOI: 10.1371/journal.pone.0212003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 12/08/2018] [Indexed: 01/21/2023] Open
Abstract
Dengue is a national priority disease in Cambodia. The Cambodian National Dengue Surveillance System is based on passive surveillance of dengue-like inpatients reported by public hospitals and on a sentinel, pediatric hospital-based active surveillance system. This system works well to assess trends but the sensitivity of the early warning and time-lag to usefully inform hospitals can be improved. During The ECOnomic development, ECOsystem MOdifications, and emerging infectious diseases Risk Evaluation (ECOMORE) project's knowledge translation platforms, Cambodian hospital staff requested an early warning tool to prepare for major outbreaks. Our objective was therefore to find adapted tools to improve the early warning system and preparedness. Dengue data was provided by the National Dengue Control Program (NDCP) and are routinely obtained through passive surveillance. The data were analyzed at the provincial level for eight Cambodian provinces during 2008-2015. The R surveillance package was used for the analysis. We evaluated the effectiveness of Bayesian algorithms to detect outbreaks using count data series, comparing the current count to an expected distribution obtained from observations of past years. The analyses bore on 78,759 patients with dengue-like syndromes. The algorithm maximizing sensitivity and specificity for the detection of major dengue outbreaks was selected in each province. The overall sensitivity and specificity were 73% and 97%, respectively, for the detection of significant outbreaks during 2008-2015. Depending on the province, sensitivity and specificity ranged from 50% to 100% and 75% to 100%, respectively. The final algorithm meets clinicians' and decisionmakers' needs, is cost-free and is easy to implement at the provincial level.
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Affiliation(s)
- Julia Ledien
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Kimsan Souv
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Centre National de Malariologie (CNM), Phnom Penh, Cambodia
| | - Rithea Leang
- Centre National de Malariologie (CNM), Phnom Penh, Cambodia
| | - Rekol Huy
- Centre National de Malariologie (CNM), Phnom Penh, Cambodia
| | - Anthony Cousien
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Mathematical Modelling of Infectious Diseases Laboratory, Institut Pasteur, Paris, France
| | - Muslim Peas
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Yves Froehlich
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Raphaël Duboz
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- UMR ASTRE CIRAD INRA, Montpellier, France
| | - Sivuth Ong
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Arnaud Tarantola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Epidemiology unit, Institut Pasteur de Nouvelle-Calédonie, Nouméa, New Caledonia
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14
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Cauchemez S, Hoze N, Cousien A, Nikolay B, Ten Bosch Q. How Modelling Can Enhance the Analysis of Imperfect Epidemic Data. Trends Parasitol 2019; 35:369-379. [PMID: 30738632 PMCID: PMC7106457 DOI: 10.1016/j.pt.2019.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/02/2023]
Abstract
Mathematical models play an increasingly important role in our understanding of the transmission and control of infectious diseases. Here, we present concrete examples illustrating how mathematical models, paired with rigorous statistical methods, are used to parse data of different levels of detail and breadth and estimate key epidemiological parameters (e.g., transmission and its determinants, severity, impact of interventions, drivers of epidemic dynamics) even when these parameters are not directly measurable, when data are limited, and when the epidemic process is only partially observed. Finally, we assess the hurdles to be taken to increase availability and applicability of these approaches in an effort to ultimately enhance their public health impact. Many data can be used to estimate the transmission potential of a pathogen, including descriptions of the transmission chains, human cluster sizes, sources of infection, and epidemic curves. An important agenda in public health is understanding the impact of control methods. However, the dynamic nature of epidemics makes this task challenging. Models can disentangle the natural course of outbreaks from the effect of external factors. In the absence of reliable surveillance data, models can reconstruct epidemic history by combining age-specific seroprevalence data with an understanding of the natural history of infection. Mechanisms of immunity are hard to observe at an individual level, yet they affect population-level dynamics. Models can tease out such signatures. Morbidity and mortality can be difficult to estimate when many infections are unobserved and severe infections are reported more often. Models can be used to correct for under-reporting and selection bias.
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Affiliation(s)
- Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France; All the authors made equal contributions.
| | - Nathanaël Hoze
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France; All the authors made equal contributions
| | - Anthony Cousien
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France; All the authors made equal contributions
| | - Birgit Nikolay
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France; All the authors made equal contributions
| | - Quirine Ten Bosch
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France; All the authors made equal contributions
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15
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Mabileau G, Dhersin JS, Yazdanpanah Y. Effectiveness and cost-effectiveness of interventions targeting harm reduction and chronic hepatitis C cascade of care in people who inject drugs: The case of France. J Viral Hepat 2018; 25:1197-1207. [PMID: 29660211 DOI: 10.1111/jvh.12919] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/06/2018] [Indexed: 12/30/2022]
Abstract
Direct-acting antivirals (DAAs) represent an opportunity to improve hepatitis C virus (HCV) care cascade. This combined with improved harm reduction interventions may lead to HCV elimination especially in people who inject drugs (PWID). We assessed the effectiveness/cost-effectiveness of improvements in harm reduction and chronic hepatitis C (CHC) care cascade in PWID in France. We used a dynamic model of HCV transmission and CHC natural history and evaluated the following: improved needle/syringe programmes-opioid substitution therapies, faster diagnosis/linkage to care, earlier treatment initiation, alone and in combination among active PWID (mean age = 36). Outcomes were as follows: life expectancy in discounted quality-adjusted life years (QALYs); direct lifetime discounted costs; incremental cost-effectiveness ratio (ICER); number of infections/reinfections. Under the current practice, life expectancy was 15.846 QALYs, for a mean lifetime cost of €20 762. Treatment initiation at F0 fibrosis stage alone was less effective and more costly than faster diagnosis/linkage to care combined with treatment initiation at F0, which increased life expectancy to 16.694 QALYs, decreased new infections by 37%, with a ICER = €5300/QALY. Combining these interventions with harm reduction improvements was the most effective scenario (life expectancy = 16.701 QALYs, 41% decrease in new infections) but was not cost-effective (ICER = €105 600/QALY); it became cost-effective with higher initial HCV incidence rates and lower harm reduction coverage than in our base-case scenario. This study illustrated the high effectiveness, and cost-effectiveness, of a faster diagnosis/linkage to care together with treatment from F0 with DAAs. This "Test and treat" strategy should play a central role both in improving the life expectancies of HCV-infected patients, and in reducing HCV transmission.
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Affiliation(s)
- A Cousien
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - V C Tran
- Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq Cedex, France
| | - S Deuffic-Burban
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,Inserm, LIRIC-UMR995, Univ Lille, Lille, France
| | - M Jauffret-Roustide
- CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société, (INSERM U988/UMR CNRS8211/Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales), Paris, France.,Institut de Veille Sanitaire, Saint-Maurice, France
| | - G Mabileau
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - J-S Dhersin
- LAGA, CNRS, UMR 7539, Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France
| | - Y Yazdanpanah
- IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
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16
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Dhersin JS, Yazdanpanah Y. Reply. Hepatology 2017; 65:2129-2130. [PMID: 28108986 DOI: 10.1002/hep.29069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Viet Chi Tran
- Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq, France
| | - Sylvie Deuffic-Burban
- IAME, UMR 1137, INSERM, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, LIRIC-UMR995, Lille, France.,Université Lille, Lille, France
| | - Marie Jauffret-Roustide
- CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société, INSERM U988/UMR CNRS8211/Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales, Paris, France.,Institut de Veille Sanitaire, Saint-Maurice, France
| | - Jean-Stéphane Dhersin
- Université Paris 13, Sorbonne Paris Cité, LAGA, CNRS, UMR 7539, Villetaneuse, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
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17
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Cousien A, Leclerc P, Morissette C, Bruneau J, Roy É, Tran VC, Yazdanpanah Y, Cox J. The need for treatment scale-up to impact HCV transmission in people who inject drugs in Montréal, Canada: a modelling study. BMC Infect Dis 2017; 17:162. [PMID: 28222681 PMCID: PMC5320702 DOI: 10.1186/s12879-017-2256-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 02/08/2017] [Indexed: 01/02/2023] Open
Abstract
Background HCV transmission remains high in people who inject drugs (PWID) in Montréal. New direct-acting antivirals (DAAs), highly effective and more tolerable than previous regimens, make a “Treatment as Prevention” (TasP) strategy more feasible. This study assesses how improvements in the cascade of care could impact hepatitis C burden among PWID in Montréal. Methods We used a dynamic model to simulate HCV incidence and prevalence after 10 years, and cirrhosis complications after 10 and 40 years. Eight scenarios of improved cascade of care were examined. Results Using a baseline incidence and prevalence of 22.1/100 person-years (PY) and 53.1%, implementing the current cascade of care using DAAs would lead to HCV incidence and prevalence estimates at 10 years of 9.4/100PY and 55.8%, respectively. Increasing the treatment initiation rate from 5%/year initially to 20%/year resulted in large decreases in incidence (6.4/100PY), prevalence (36.6%), and cirrhosis complications (−18%/-37% after 10/40 years). When restricting treatment to fibrosis level ≥ F2 instead of F0 (reference scenario), such decreases in HCV occurrence were unreachable. Improving the whole cascade of care led to the greatest effect by halving both the incidence and prevalence at 10 years, and the number of cirrhosis complications after 40 years. Conclusions The current level of treatment access in Montréal is limiting a massive decrease in hepatitis C burden among PWID. A substantial treatment scale-up, regardless of fibrosis level, is necessary. While improving the rest of the cascade of care is necessary to optimize a TasP strategy and control the HCV epidemic, a treatment scale-up is first needed. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2256-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.,Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada
| | - Pascale Leclerc
- Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada
| | - Carole Morissette
- Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada
| | - Julie Bruneau
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC, H2X 0A9, Canada
| | - Élise Roy
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Campus Longueuil, 150 place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Viet Chi Tran
- Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
| | - Joseph Cox
- Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, 1301 rue Sherbrooke est, Montréal, QC, H2L 1M3, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A3, Canada. .,Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A3J1, Canada.
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18
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Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France
| | - Sylvie Deuffic-Burban
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.,Inserm, LIRIC-UMR995, F-59000, Univ Lille, F-59000, Lille, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Dhersin JS, Yazdanpanah Y. Hepatitis C treatment as prevention of viral transmission and liver-related morbidity in persons who inject drugs. Hepatology 2016; 63:1090-101. [PMID: 26390137 DOI: 10.1002/hep.28227] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/13/2015] [Indexed: 01/08/2023]
Abstract
UNLABELLED Hepatitis C virus (HCV) seroprevalence remains high in people who inject drug (PWID) populations, often above 60%. Highly effective direct-acting antiviral (DAA) regimens (90% efficacy) are becoming available for HCV treatment. This therapeutic revolution raises the possibility of eliminating HCV from this population. However, for this, an effective cascade of care is required. In the context of the available DAA therapies, we used a dynamic individual-based model including a model of the PWID social network to simulate the impact of improved testing, linkage to care, and adherence to treatment, and of modified treatment recommendation on the transmission and on the morbidity of HCV in PWID in France. Under the current incidence and cascade of care, with treatment initiated at fibrosis stage ≥F2, HCV prevalence decreased from 42.8% to 24.9% (95% confidence interval: 24.8-24.9) after 10 years. Changing treatment initiation criteria to treat from F0 was the only intervention leading to a substantial additional decrease in prevalence, which fell to 11.6% (95% CI: 11.6-11.7) at 10 years. Combining this change with improved testing, linkage to care, and adherence to treatment decreased HCV prevalence to 7.0% (95% CI: 7.0-7.1) at 10 years and avoided 15% (95% CI: 14-17) and 29% (95% CI: 28-30) of cirrhosis complications over 10 and 40 years, respectively. CONCLUSIONS Major decreases in prevalent HCV infections occur only when treatment is initiated at early stages of fibrosis, suggesting that systematic treatment in PWID, where incidence remains high, would be beneficial. However, elimination within the 10 next years will be difficult to achieve using treatment alone, even with a highly improved cascade of care.
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Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Viet Chi Tran
- Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq, France
| | - Sylvie Deuffic-Burban
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Inserm, LIRIC-UMR995, Lille, France, Université Lille, Lille, France
| | - Marie Jauffret-Roustide
- CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société, (INSERM U988/UMR CNRS8211/Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales), Paris, France.,Institut de Veille Sanitaire, Saint-Maurice, France
| | - Jean-Stéphane Dhersin
- Université Paris 13, Sorbonne Paris Cité, LAGA, CNRS, UMR 7539, Villetaneuse, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
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20
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Clémençon S, Cousien A, Felipe MD, Tran VC. On computer-intensive simulation and estimation methods for rare-event analysis in epidemic models. Stat Med 2015; 34:3696-713. [PMID: 26242476 DOI: 10.1002/sim.6596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 06/02/2015] [Accepted: 07/04/2015] [Indexed: 11/07/2022]
Abstract
This article focuses, in the context of epidemic models, on rare events that may possibly correspond to crisis situations from the perspective of public health. In general, no close analytic form for their occurrence probabilities is available, and crude Monte Carlo procedures fail. We show how recent intensive computer simulation techniques, such as interacting branching particle methods, can be used for estimation purposes, as well as for generating model paths that correspond to realizations of such events. Applications of these simulation-based methods to several epidemic models fitted from real datasets are also considered and discussed thoroughly.
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Affiliation(s)
- Stéphan Clémençon
- Institut Telecom LTCI UMR Telecom ParisTech/CNRS No. 5141, F-75634, Paris, France
| | - Anthony Cousien
- INSERM, IAME, UMR 1137, Paris, F-75018, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France
| | | | - Viet Chi Tran
- Laboratoire P. Painlevé UFR de Mathématiques UMR CNRS 8524, Université des Sciences et Technologies Lille 1, Villeneuve d'Ascq Cedex, F-59955, France
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21
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Obach D, Yazdanpanah Y, Esmat G, Avihingsanon A, Dewedar S, Durier N, Attia A, Anwar WA, Cousien A, Tangkijvanich P, Eholié SP, Doss W, Mostafa A, Fontanet A, Mohamed MK, Deuffic-Burban S. How to optimize hepatitis C virus treatment impact on life years saved in resource-constrained countries. Hepatology 2015; 62:31-9. [PMID: 25581111 DOI: 10.1002/hep.27691] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/06/2015] [Indexed: 01/15/2023]
Abstract
UNLABELLED In resource-constrained countries where the prevalence of hepatitis C virus (HCV) disease is usually high, it is important to know which population should be treated first in order to increase treatment effectiveness. The aim was to estimate the effectiveness of different HCV treatment eligibility scenarios in three different countries. Using a Markov model, we estimated the number of life-years saved (LYS) with different treatment eligibility scenarios according to fibrosis stage (F1-F4 or F3-4), compared to base case (F2-F4), at a constant treatment rate, of patients between 18 and 60 years of age, at stages F0/F1 to F4, without liver complications or coinfections, chronically infected by HCV, and treated with pegylated interferon (IFN)/ribavirin or more-efficacious therapies (i.e. IFN free). We conducted the analysis in Egypt (prevalence = 14.7%; 45,000 patients treated/year), Thailand (prevalence = 2.2%; 1,000 patients treated/year), and Côte d'Ivoire (prevalence = 3%; 150 patients treated/year). In Egypt, treating F1 patients in addition to ≥F2 patients (SE1 vs. SE0) decreased LYS by 3.9%. Focusing treatment only on F3-F4 patients increased LYS by 6.7% (SE2 vs. SE0). In Thailand and Côte d'Ivoire, focusing treatment only on F3-F4 patients increased LYS by 15.3% and 11.0%, respectively, compared to treating patients ≥F2 (ST0 and SC0, respectively). Treatment only for patients at stages F3-F4 with IFN-free therapies would increase LYS by 16.7% versus SE0 in Egypt, 22.0% versus ST0 in Thailand, and 13.1% versus SC0 in Côte d'Ivoire. In this study, we did not take into account the yearly new infections and the impact of treatment on HCV transmission. CONCLUSION Our model-based analysis demonstrates that prioritizing treatment in F3-F4 patients in resource-constrained countries is the most effective scenario in terms of LYS, regardless of treatment considered.
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Affiliation(s)
- Dorothée Obach
- Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Yazdan Yazdanpanah
- Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France
| | - Gamal Esmat
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Anchalee Avihingsanon
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand.,Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sahar Dewedar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nicolas Durier
- TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand
| | - Alain Attia
- UFR des Sciences Médicales, Université Félix Houphouet Boigny de Cocody, Abidjan, Côte d'Ivoire.,Service de Médecine et d'Hépato-Gastroentérologie, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Wagida A Anwar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anthony Cousien
- Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Pisit Tangkijvanich
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Serge Paul Eholié
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.,Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Abidjan, Côte d'Ivoire.,Programme PAC-CI, ANRS, Abidjan, Côte d'Ivoire
| | - Wahid Doss
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Arnaud Fontanet
- Institut Pasteur, Emerging Disease Epidemiology Unit, Paris, France.,Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Mostafa K Mohamed
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sylvie Deuffic-Burban
- Inserm UMR 1137, IAME, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Inserm U995, Université Lille Nord de France, Lille, France
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22
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Dhersin JS, Yazdanpanah Y. Dynamic modelling of hepatitis C virus transmission among people who inject drugs: a methodological review. J Viral Hepat 2015; 22:213-29. [PMID: 25270261 DOI: 10.1111/jvh.12337] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/25/2014] [Indexed: 12/09/2022]
Abstract
Equipment sharing among people who inject drugs (PWID) is a key risk factor in infection by hepatitis C virus (HCV). Both the effectiveness and cost-effectiveness of interventions aimed at reducing HCV transmission in this population (such as opioid substitution therapy, needle exchange programmes or improved treatment) are difficult to evaluate using field surveys. Ethical issues and complicated access to the PWID population make it difficult to gather epidemiological data. In this context, mathematical modelling of HCV transmission is a useful alternative for comparing the cost and effectiveness of various interventions. Several models have been developed in the past few years. They are often based on strong hypotheses concerning the population structure. This review presents compartmental and individual-based models to underline their strengths and limits in the context of HCV infection among PWID. The final section discusses the main results of the papers.
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Affiliation(s)
- A Cousien
- IAME, UMR 1137, INSERM, Paris, France; IAME, UMR 1137, Sorbonne Paris Cité, Univ Paris Diderot, Paris, France
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23
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Cousien A, Obach D, Deuffic-Burban S, Mostafa A, Esmat G, Canva V, El Kassas M, El-Sayed M, Anwar WA, Fontanet A, Mohamed MK, Yazdanpanah Y. Is expert opinion reliable when estimating transition probabilities? The case of HCV-related cirrhosis in Egypt. BMC Med Res Methodol 2014; 14:39. [PMID: 24635942 PMCID: PMC4003824 DOI: 10.1186/1471-2288-14-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 01/30/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Data on HCV-related cirrhosis progression are scarce in developing countries in general, and in Egypt in particular. The objective of this study was to estimate the probability of death and transition between different health stages of HCV (compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma) for an Egyptian population of patients with HCV-related cirrhosis. METHODS We used the "elicitation of expert opinions" method to obtain collective knowledge from a panel of 23 Egyptian experts (among whom 17 were hepatologists or gastroenterologists and 2 were infectiologists). The questionnaire was based on virtual medical cases and asked the experts to assess probability of death or probability of various cirrhosis complications. The design was a Delphi study: we attempted to obtain a consensus between experts via a series of questionnaires interspersed with group response feedback. RESULTS We found substantial disparity between experts' answers, and no consensus was reached at the end of the process. Moreover, we obtained high death probability and high risk of hepatocellular carcinoma. The annual transition probability to death was estimated at between 10.1% and 61.5% and the annual probability of occurrence of hepatocellular carcinoma was estimated at between 16.8% and 58.9% (depending on age, gender, time spent in cirrhosis and cirrhosis severity). CONCLUSIONS Our results show that eliciting expert opinions is not suited for determining the natural history of diseases due to practitioners' difficulties in evaluating quantities. Cognitive bias occurring during this type of study might explain our results.
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Affiliation(s)
- Anthony Cousien
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- EA2694, Université Lille Nord de France, Lille, France
| | - Dorothée Obach
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- EA2694, Université Lille Nord de France, Lille, France
| | - Sylvie Deuffic-Burban
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- Inserm U995, Université Lille 2 – Lille Nord de France, Lille, France
| | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Gamal Esmat
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Valérie Canva
- Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, France
| | - Mohamed El Kassas
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohammad El-Sayed
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wagida A Anwar
- Department of Community, Environmental and Occupational Medicine, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Arnaud Fontanet
- Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Mostafa K Mohamed
- Department of Community, Environmental and Occupational Medicine, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
- Service de Maladies infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France
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24
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Obach D, Deuffic-Burban S, Esmat G, Anwar WA, Dewedar S, Canva V, Cousien A, Doss W, Mostafa A, Pol S, Buti M, Siebert U, Fontanet A, Mohamed MK, Yazdanpanah Y. Effectiveness and cost-effectiveness of immediate versus delayed treatment of hepatitis C virus-infected patients in a country with limited resources: the case of Egypt. Clin Infect Dis 2014; 58:1064-71. [PMID: 24510934 DOI: 10.1093/cid/ciu066] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Because of logistical and economic issues, in Egypt, as in other resource-limited settings, decision makers should determine for which patients hepatitis C virus (HCV) treatment should be prioritized. We assessed the effectiveness and cost-effectiveness of different treatment initiation strategies. METHODS Using a Markov model, we simulated HCV disease in chronically infected patients in Egypt, to compare lifetime costs, quality-adjusted life expectancy (QALE), and the incremental cost-effectiveness ratio (ICER) of different treatment initiation strategies. RESULTS Immediate treatment of patients at stages F1/F2/F3 was less expensive and more effective than delaying treatment until more severe stages or not providing treatment (in patients diagnosed at F1: QALE = 18.32 years if treatment at F1 vs 18.22 if treatment at F2). Treatment of F4 patients was more effective than no treatment at all (QALE = 10.33 years vs 8.77 years) and was cost-effective (ICER = $1915/quality-adjusted life-year [QALY]). When considering that affordable triple therapies, including new direct-acting antivirals, will be available starting in 2016, delaying treatment until stage F2, then treating all patients regardless of their disease stage after 2016, was found to be cost-effective (ICER = $33/QALY). CONCLUSIONS In Egypt, immediate treatment of patients with fibrosis stage F1-F3 who present to care is less expensive and more effective than delaying treatment. However, immediate treatment at stage F1 is only slightly more effective than waiting for disease to progress to stage F2 before starting treatment and is sensitive to the forthcoming availability of new treatments. Treating patients at stage F4 is highly effective and cost-effective. In Egypt, decision makers should prioritize treatment for F4 patients and delay treatment for F1 patients who present to care.
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Affiliation(s)
- Dorothée Obach
- IAME, UMR 1137, Inserm, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
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25
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Champenois K, Cousien A, Cuzin L, Le Vu S, Deuffic-Burban S, Lanoy E, Lacombe K, Patey O, Béchu P, Calvez M, Semaille C, Yazdanpanah Y. Missed opportunities for HIV testing in newly-HIV-diagnosed patients, a cross sectional study. BMC Infect Dis 2013; 13:200. [PMID: 23638870 PMCID: PMC3652743 DOI: 10.1186/1471-2334-13-200] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/19/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In France, 1/3 HIV-infected patients is diagnosed at an advanced stage of the disease. We describe missed opportunities for earlier HIV testing in newly-HIV-diagnosed patients. METHODS Cross sectional study. Adults living in France for ≥1 year, diagnosed with HIV-infection ≤6 months earlier, were included from 06/2009 to 10/2010. We collected information on patient characteristics at diagnosis, history of HIV testing, contacts with healthcare settings, and occurrence of HIV-related events 3 years prior to HIV diagnosis. During these 3 years, we assessed whether or not HIV testing had been proposed by the healthcare provider upon first contact in patients notifying that they were MSM or had HIV-related conditions. RESULTS 1,008 newly HIV-diagnosed patients (mean age: 39 years; male: 79%; MSM: 53%; diagnosed with an AIDS-defining event: 16%). During the 3-year period prior to HIV diagnosis, 99% of participants had frequented a healthcare setting and 89% had seen a general practitioner at least once a year. During a contact with a healthcare setting, 91/191 MSM (48%) with no HIV-related conditions, said being MSM; 50 of these (55%) did not have any HIV test proposal. Only 21% (41/191) of overall MSM who visited a healthcare provider received a test proposal. Likewise, 299/364 patients (82%) who sought care for s had a missed opportunity for HIV testing. CONCLUSIONS Under current screening policies, missed opportunities for HIV testing remain unacceptably high. This argues in favor of improving risk assessment, and HIV-related conditions recognition in all healthcare facilities.
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Affiliation(s)
- Karen Champenois
- ATIP-Avenir Inserm: Modélisation, Aide à la Décision, et Coût-Efficacité en Maladies Infectieuses, 152 rue du professeur Yersin, Loos 59120, France.
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26
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Champenois K, Cousien A, Ndiaye B, Soukouna Y, Baclet V, Alcaraz I, Choisy P, Chaud P, Velter A, Gallay A, Yazdanpanah Y. Risk factors for syphilis infection in men who have sex with men: results of a case-control study in Lille, France. Sex Transm Infect 2012; 89:128-32. [PMID: 22679099 DOI: 10.1136/sextrans-2012-050523] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Substantial increases in syphilis have been reported since the early 2000s in northern countries, particularly among men who have sex with men (MSM). The authors aimed to identify risk factors for early syphilis in MSM in Lille, a large urban area of northern France. METHODS A matched case-control study was conducted in MSM aged ≥ 18 years. Cases were diagnosed with primary, secondary or early latent syphilis between April 2008 and June 2010. Controls sought care in STIs clinics or were followed in an HIV clinic. Controls had no history of and no current syphilis. They were matched to cases for age and HIV status. Multivariate conditional logistic regression models were used to identify risk factors for early syphilis. RESULTS 53 patients with early syphilis were enrolled. Average age was 37 years, and 47% were HIV-infected. For analysis, they were matched to 90 controls. Factors associated with syphilis were: low educational attainment (OR=5.38, 95% CI 1.94 to 14.94; p=0.001), receptive oral sex with casual male partners without a condom (OR=4.86, 95% CI 1.63 to 14.48; p=0.005) and anal sex toy use with casual male partners (OR=2.72, 95% CI 1.01 to 7.32; p=0.05). Seeking of sex partners online (OR=5.17, 95% CI 1.33 to 20.11), use of poppers (OR=2.2, 95% CI 1.1 to 4.3) and erectile dysfunction drugs (OR=1.9, 95% CI 1.0 to 13.2) were associated with syphilis only in the univariate analysis. CONCLUSIONS Receptive oral sex without a condom and use of anal sex toys were identified as presenting a major risk of syphilis infection. Although these practices have been shown to present low risk of HIV transmission, the general public is unaware of their impact on transmission of other STIs.
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Affiliation(s)
- Karen Champenois
- ATIP-Avenir Inserm: Modélisation, Aide à la Décision, et Coût-Efficacité en Maladies Infectieuses, Lille, France.
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