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: The treatment of high priority populations, including patients actively using intravenous drugs (active PWID), must be prioritized to accomplish the WHO HCV elimination goals by 2030. Simplification of the treatment cascade is key to reaching this goal, even more so in the COVID-19 era Sofosbuvir/velpatasvir (SOF/VEL) is a protease inhibitor-free, pangenotypic, panfibrotic, single duration, single tablet regimen, to be taken without regards to food and with limited drug-drug interactions This real-world analysis evaluates SOF/VEL as a simple strategy to implement a testand- treat approach in HCV-infected active PWID Methods: Adult active PWID treated for HCV with 12 weeks SOF/VEL in different clinical settings were included from 25 cohorts in 6 countries Patients with a history of decompensation or prior NS5A-inhibitor exposure were excluded The endpoints were HCV cure (undetectable HCV RNA ≥12 after the end of therapy, SVR12) and time-to-treatment (TT) between most recent HCV RNA measurement and SOF/VEL treatment start Results: Analysis included 340 patients, mean age 44±10years, 84% male, 15% compensated cirrhotic (CC) and 8% treatment-experienced, with 43% genotype (GT) 1 and 41% GT3 73% of patients were diagnosed with a mental disorder, 27% were homeless and 21% incarcerated Of patients with TT available (n=334), 10% were treated the same day of diagnosis, 16% within 1 week, 39% within 1 month, and 69% within 3 months Treatment adherence below 90% was observed in 24 patients (8%) SVR12 is available for 254 patients (75%), as non-virological or unknown cause of failure was documented in 86 patients (25%), 79% due to lost-to-follow-up (LTFU) SVR12 was 98% overall (249/254), 98% (80/82) in non-cirrhotic and 95% (20/21) in CC patients Active PWID with mental disorders showed 97% SVR12 (181/186) Of active PWID with GT3 infection, 96% (104/180) were cured, including 95% (20/21) of those with CC Of 31 patients starting treatment within 1 week of diagnosis, all achieved SVR12 compared to 126/129 (98%) starting within 3 months of diagnosis Conclusion: SOF/VEL is a simple HCV treatment resulting in high cure rates in active PWID, including patients with multiple complicating factors LTFU remains a challenge in this population The simplicity of the SOF/VEL approach allowing for shortening of the patient care cascade and rapid treatment starts with high cure rates may help address this important issue.
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.
ABSTRACT
Background: Stigma and poor linkage to care, amplified in the setting of the COVID-19 pandemic, are significant barriers for treating hepatitis C (HCV) in vulnerable patients, reducing our ability to implement a rapid test and treat (TnT) strategy with minimal monitoring within a simple patient cascade, as currently available HCV therapies would allow us to do This real-world analysis evaluates our ability to implement this approach in both general (GP) and vulnerable (VP) populations Methods: HCV-infected patients from 32 clinical cohorts in 8 countries treated with sofosbuvir/ velpatasvir without a history of decompensation or prior NS5A-inhibitor exposure were included in this analysis The VP included prisoners, homeless patients and patients with mental disorders Time to treatment (TT) between the most recent HCV RNA measurement and treatment initiation was estimated based on available data Results: A total of 2449 patients were included, 937 in GP (58% males), 1512 (72% males) in VP (59% with mental disorders, 31% homeless, 10% imprisoned) Mean age [standard deviation] was 55 [14] and 50 [14] years in GP and VP respectively Genotype 3 was observed in 35% and 33% respectively, compensated cirrhosis confirmed in 20% and 18% of GP versus VP. The median TT [MTT, interquartile range] was 55 days [23- 107] in GP and 60 days [27-132] in VP The longest MTT of 66 days [32-134] was observed in patients with mental disorders MTT was 63 days [29-149] in prisoners and 27 days [13-71] among the homeless Only 13% of GP and 8% of VP were treated the same day of diagnosis, and 70% of GP and 63% of VP were treated within 3 months In patients with mental disorders only 4% were treated the same day of diagnosis Cure rates were high and consistent with previously reported cure rates Conclusion: MTT varies across HCV patient groups, from over 6 months to 1 day This analysis shows that a quick treatment start is possible, both in general population and in vulnerable populations, supporting the feasibility of a TnT approach in all populations New strategies should be considered to engage patients with mental disorders in this model of care more effectively.