ABSTRACT
This study provides an update on hepatitis C virus (HCV) estimates across Italy up to January 2021. A mathematical probabilistic modelling approach, including a Markov chain for liver disease progression, was used to estimate current HCV viraemic burden. Prevalence was defined by geographic area using an estimated annual historical HCV incidence by age, treatment, and migration rate from the Italian National database (ISTAT). Viraemic infection was estimated for the main HCV transmission routes by stages F0-F3 (patients without liver cirrhosis, i.e., potentially asymptomatic liver disease) and F4 (patients with liver cirrhosis, i.e., potentially symptomatic liver disease). By January 2021, we estimated that there were 398,610 individuals in Italy with active HCV infection (prevalence of 0.66%;95% CI: 0.66-0.67), of which 287,730 (0.48%;95% CI: 0.46-0.59%) were stage F0-F3. Prevalence values for all individuals with active HCV infection were: North 0.54% (95% CI: 0.53-0.54%), Central 0.88% (95% CI: 0.87-0.89%), South 0.72% (95% CI: 0.71-0.73%), and the Isles 0.67% (95% CI: 0.66-0.68%). The population at risk for previous/current drug injection accounted for 48.6% of all individuals with active HCV infection. A modelling approach such as this to estimate and update the prevalence of active HCV infection could be a useful methodology for the evaluation of healthcare policies related to HCV elimination plans.
ABSTRACT
Viral hepatitis C is an important public health problem and its elimination by 2030, defined by the World Health Organization, is an ambitious goal. The chance of free screening for HCV infection represents an important achievement that requires a successful State-Regions coordination and an effective regional organisation, that guarantees an interdisciplinary course between local and specialized healthcare. A structured communication program to increase the sensitivity of target populations as well as health professionals is the key for success. The implementation of the proactive screening, defined by the Milleproroghe Law, is crucial because it will define the tracks for the whole HCV costeffective screening strategies (1948-1988 birth cohorts) required to achieve the HCV elimination targets in Italy by 2030.
ABSTRACT
Although Italy has been on track for Hepatitis C Virus (HCV) elimination since 2019, it fell off track due to the decrease in the number of treated patients. HCV elimination in Italy will be possible if immediate action is taken. A health policy was implemented beginning in 2021, consisting of screening among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The active screening requires regional governance that manages the processes' complexity integrating a well-organized network between territory assistance and hospital to achieve an effective HCV care cascade. This document aims to support the regional decision-making process by defining paths for screening and linkage-to-care. Implementing active screening strategies beyond a risk-based approach is required as a General Practitioners' task. Simplified paths must be drawn for the key populations screening. The infrastructure built for COVID-19 vaccination could be used also for HCV screening. According to a multidisciplinary care delivery, screening should be supplemented with rapid linkage-to-care and treatment of newly diagnosed patients. The realization of the proactive screening during the first two years is vital because it will define the tracks for the whole HCV cost-effective screening of 1948-1988 birth cohorts in Italy.
ABSTRACT
Background: COVID-19 has placed significant strain on national healthcare systems at a critical moment in the context of hepatitis elimination Mathematical models can be used to evaluate the possible impact of programmatic delays on hepatitis disease burden The objective of this analysis was to evaluate the incremental change in hepatitis C liverrelated deaths and liver cancer, following a 3-month, 6-month, or 1-year hiatus in hepatitis elimination program progress Methods: Previously developed models were adapted for 110 countries to include a status quo or “no delay” scenario and a “1-year delay” scenario assuming significant disruption in interventions (screening, diagnosis and treatment) in the year 2020 Annual, country-level, model outcomes were extracted, and weighted averages were used to calculate regional (WHO and World Bank Income Group) and global estimates from 2020 to 2030 The incremental annual change in outcomes was calculated by subtracting the “no-delay” estimates from the “1-year delay” estimates Results: The “1-year delay” scenario resulted in 44,800 (95% UI: 43,800 - 49,300) excess hepatocellular carcinoma (HCC) cases and 72,300 (95% UI: 70,600 - 79,400) excess liver-related deaths (LRDs), relative to the “no delay” scenario globally, from 2020-2030 Most missed treatments would be in lower-middle income countries, while most excess HCC and LRDs would be among high-income countries Under the “1-year delay” scenario, no regions were projected to reach the WHO targets for diagnosis, treatment or incidence, and only the highincome country group was projected to achieve the target for liver-related deaths Conclusion: The impact of COVID-19 extends beyond the direct morbidity and mortality associated with exposure and infection In order to mitigate the impact on viral hepatitis programming and reduce excess mortality from delayed treatment, policy makers should prioritize hepatitis programs as soon as it becomes safe to do so. (Table Presented).