ABSTRACT
Background: Elimination of Hepatitis C Virus (HCV) infection in individuals with substance use disorders (SUD) is key to achieve the WHO goal by 2030. However, HCV screening and treatment of these subjects is challenging . The aim of this study was to assess the level of attendance and the incidence of HCV infection during the COVID-19 pandemic in a cohort of subjects with SUD who had previously been screened in an addiction center. Methods: Prospective study conducted in an addiction center that included subjects with SUD, previously (2018-2019) screened for HCV, who were offered treatment by a multidisciplinary team in the addiction center. After 18 months, during the COVID-19 pandemic, they were offered HCV screening again to assess the incidence of new infections and reinfections. Results: In the first study, HCV screening was offered to 528 individuals with SUD but only 401 accepted. Of these, 112 (30%) were anti-HCV positive and 42 (10%) HCV-RNA positive and elegible for therapy. Direct-acting antivirals (DAAs) were started in 15 (24%) and all achieved sustained virological response. The main reason for non starting DAAs was loss of follow-up. After 18 months, only 242 (60%) of the 401 previously tested were still linked to the center and 176 (72%) agreed to be screened. Anti-HCV antibodies were detected in 58 (33%) and HCVRNA was detected in 6 (3.4%): 4 with known infection who had previously refused therapy and 2 (1.1%) new infections. Among those previously treated no case of HCV reinfection was detected.Attendance to the addiction center was lower in young subjects (44 ± 12 vs 47 ± 11, p=0.02) in those not receiving opiod substitution therapy (30% vs 70%, p=0.008) and among cocaine users (45% vs 55%, p=0.049). Previous psychiatric disorders were associated with higher linkage to the addiction center during follow-up (66% vs 34%, p=0.003). Conclusion: Despite a descentralized model of care, a high number of individulas with SUD do not accept HCV screening. The HCV prevalence and incidence of new infection is high in this population and the attendance to addiction centers low, with a 40% dropout rate. There are significant differences in terms of demographic, clinical and substance use variables between attending patients and those who abandon followup.
ABSTRACT
Epidemic episodes such as the COVID-19 has shown the need for simulation tools to support decision making, predict the results of control actions, and mitigating the effects of the virus. Simulation methods have been widely used by healthcare researchers and practitioners to improve the planning and management of hospitals and predict the spread of disease. Simulating all involved aspects of an epidemic episode requires the modelling and simulation of large and complex Discrete Event Systems (DESs), supported by modular and hierarchical models easy to use for experts, and that can be translated to efficient code for distributed simulation. This paper presents a model driven engineering (MDE) approach to support the modelling of healthcare systems (HS) in epidemic episodes combining different perspectives, and the translation to efficient code for scalable distributed simulations. © 2020, Springer Nature Switzerland AG.
ABSTRACT
Background: The lockdown during the COVID-19 pandemic had an strong impact on the management of patients with liver diseases in Spain We analyzed the impact of the lockdown period on PWID with ongoing high-risk practices attending an externalized hepatology outpatient clinic at the biggest harm reduction center (HRC) in Barcelona Methods: On site HCV point-of-care screening for HCV-IgG antibody and HCV-RNA (GenXpert®), liver stiffness measurement (LSM), antiviral therapy delivery and sustained virological response (SVR12) assessment were performed at the HRC Dried blood spot (DBS) was collected at baseline, SVR12 and every 6 months in order to differentiate relapse vs reinfection Adherence was assessed by daily or weekly visits The program included educative and harm-reduction interventions Results: Before the lockdown 845 individuals had been prospectively enrolled in the program Of these, 386 (46%) accepted HCV screening, of whom 212 (55%) were HCV-RNA positive Of the 149 (70%) individuals who already started treatment, median (P25-P75) age was 42 years (35-47), 86% were male, 45% foreigners, 33% homeless, 73% unemployed and 62% had been imprisoned before At enrolment, 72% injected daily (55% more than once a day) In regard to high risk practices, 30% reported either needle or paraphernalia sharing and 38% unprotected sexual relationships Baseline LSM values were 6 (4 9-7 6) kPa with 12% patients having advanced fibrosis (>9.5 kPa). All patients received pan-genotypic antiviral therapy either 8 or 12 weeks During Spain's lockdown period the center's attendance was reduced from 300 users/day to 70 users/day and the program recruitment rate from 6 6 to 1 3 individuals/day No patient initiated antiviral therapy during this period Overall 34 (28%) missed their follow-up visits during this period, including 4/10 patients under ongoing antiviral therapy The overall reinfection rate was 16/100 patients/year, 4(23%) happened after lockdown Although there was an increase in the use of drugs on the street/at home, 50% reduced the injection frequency during the lockdown period Conclusion: This patient-centered circuit demonstrates that HCV treatment can be successfully delivered to active PWID with high-risk practices However, the lockdown had a negative impact on loses to follow-up and also altered drug consumption habits, supporting the role of specific interventions.