ABSTRACT
Diagnosis of alpha1-antitrypsin deficiency, a rare genetic disorder, consists of biochemical serum analysis to evaluate protein deficiency and electrophoretic abnormalities, as well as genetic analysis to identify SERPINA1 gene variants responsible for the protein deficiency. In majority of European countries diagnostic is centralized, blood and/or DNA samples are referred to dedicated reference laboratories. We aimed at analyzing data reported by the 8 leading European centers (AATD LABnet part of the EARCO ERS CRC and ERN-LUNG activities) to assess the effect of COVID-19 pandemic and healthcare disruption on the AATD diagnostic provision. In total, the number of tests dropped in 2020 vs 2019 by -20,43% (+/-13,25) for AAT concentration analysis, -25,5% (+/-12,79) for AAT phenotyping and -23,57% (+/-10,28) for SERPINA1 genotyping, while in 2021 vs 2019 by respectively -16,86% (+/-21,34), -9,2% (+/-30,38), -13,57% (+/-40,82). Specifically, diagnostics in Poland and Italy were affected the most with -48% and -28% fewer samples analyzed (2021 vs 2019, phenotyping), while in France and Portugal referrals recovered by the end of 2021, with + 18% and +29% respectively (2021 vs 2019, genotyping). Disorganization of healthcare provision due to the COVID-19 pandemic severely disrupted AATD diagnostics in Europe. In some countries the detrimental effect was temporary, while in others it continued in 2021.
ABSTRACT
Background: There are patients with Hepatitis C Virus (HCV) infection previously diagnosed and lost to follow-up (LTFU) in the health system. Strategies to identify and linkage to care are necessary to achieve HCV elimination. The aims were to evaluate the impact of COVID-19 pandemic on LTFU patients in searching and retrieving HCV-RNA+ve individuals susceptible to treatment (ReLink-C strategy) and perform a health economic evaluation. Methods: ReLink-C strategy was based on a retrospective search of the microbiology databases of Barcelona north health area (450,000 inhabitants), followed by medical records review to identify and retrieve LTFU of HCV-RNA+ve individuals. Candidates for contacting were called (5 times maximum) to offer them a medical visit, reevaluation and subsequent treatment with direct-acting antivirals (DAAs). The search was done into two periods (pre-COVID, Jan 2019 to Feb 2020 and COVID, Mar 2020 to Dic 2020) to assess the impact of COVID on LTFU patients. In the economic evaluation, the costs of ReLink-C strategy were calculated, and a Markov model was used to estimate lifetime cases of liver complications, liver-related mortality and costs associated, compared to non-intervention. Results: Overall (01/2019 to 12/2020), 1,415 HCV-RNA+ve individuals were detected, 774 were selected for retrieval and 158 candidates for contact (The Figure shows the flowchart). After 5 calls, 99 individuals were located and 47 agreed to a visit. Finally, 41 individuals attended the visit and 38 started and completed DAA treatment. During COVID period, a higher percentage of individuals were selected for retrieval (65 vs 51%) and a lower percentage were candidates for contact (6 vs 13%) and located (4 vs 8%) comparing to pre-COVID period. At the end, a similar percentage of cases started treatment. The cost of ReLink-C strategy was €23.830 (search and diagnosis). During lifetime horizon, for a cohort of 133 viremic patients (158 candidates to contact excluding 23 treated, 1 death and 1 spontaneous cure) (38 treated in ReLink-C vs not treated in non-intervention), ReLink-C avoided 10 cases of decompensated cirrhosis, 6 hepatocellular carcinomas and 1 liver transplant, saving €423,372 associated to their management;deaths were reduced by 26%. Conclusion: Relink-C strategy retrieved and treated a high number of LTFU patients and showed to be cost-effective. COVID had a relevant impact on the linkage to care and treatment of HCV patients.
ABSTRACT
Background: African migrant populations living in Europe are disproportionately affected by HBV infection. Chronic HBV infection is a major public health threat for African migrant populations living in Spain who use health services at lower rates due to structural and/or cultural/linguistic barriers. Efforts to scale up prevention, testing and treatment are needed to reach the 2030 hepatitis elimination targets set by the WHO. TheHBV-COMSAVA study aims to use pointof-care testing and simplified diagnostic tools in community settings to identify and link to care or vaccinate west African migrants in the greater Barcelona area during the ongoing COVID-19 pandemic. Methods: 280 study participants were offered HBV screening in a pop-up clinic in a community setting from 21/11/20- 6/6/21 Rapid tests to screen for the presence of HBsAg were used and a blood sample was collected using plasma separation cards and analyzed in a laboratory. Patients received their results during a second visit and were offered: a) linkage to specialist care);b) posttest counselling;or c) vaccination of the first dose of the HBV vaccine in situ. Sociodemographic and clinical history were collected and basic standard descriptive statistics were utilized using STATA software. Participants who did not already have Catalonia's CatSalut health card were offered an expedited processing system to acquire one. Results: Five participants were excluded and 275 were included for analysis. The overall HBsAg prevalence was 12.7% (n=35). Of those included, laboratory results are available for 229 (83.3%). Of these, anti-HBc positivity was detected in 31.9% (n=73). The majority (44.4%, n=122) required vaccination against HBV followed by post-test counselling (30.9%, n=85) and referral to a specialist (12.7%, n=35). Of those who received their results (n=243), 75.7% returned and either received post-test counselling, linkage to specialist care, or the first dose of the HBV vaccine (figure 1). The HBV vaccination acceptance rate was 86.4%. Eight participants did not have access to the public health system and requested CatSalut cards and all were provided with one Conclusion: Despite the COVID-19 pandemic, by employing a community-based model of care utilizing novel simplified diagnostic tools the HBV-COMSAVA study demonstrated the possibility to screen, diagnose, link to care, and vaccinate African migrants who may otherwise not have received care.
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.