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European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1514901


Background Early on in the COVID-19 pandemic, scientific community highlighted the potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released and stringent containment measures quickly implemented, including access restriction to essential staff only. During the 2nd epidemic wave prevention strategies were gradually relaxed, visitors were readmitted and people in prison (PiP) activities were repristinated. Here, we describe the spread of COVID-19 in 18 detention facilities in Lombardy region, Italy, during the 1st(Mar-Jul 2020) and 2nd(Oct 2020-Feb 2021) waves and the impact of prevention and control measures implemented in prison. Methods We conducted a descriptive retrospective analysis of cases' distribution. Moreover, a comparison among the epidemic burden affecting POs and PiP and a correlation analysis between the number of cases occurred and prevention measures implemented were carried out. Results Our population consists of a monthly average of 2269 prison officers (POs) and 7604 PiP. POs were at higher risk of contracting COVID-19 during both waves. Occurrence of cases among PiP was temporally associated with cases among POs. There was heterogeneity in the size of outbreaks across different prison facilities. During the second wave, COVID-19 spread more widely in prison both among POs (2ndwave attack rate (AR) per 1000 individuals: 27.2;monthly range (MR): 0.9-64.5 vs 1stwave AR 2.4;MR: 0.0-12.1) and PiP (2ndwave AR: 23.5;MR: 11.6-50.8 vs 1stwave AR 1.6;MR: 0-5.2). Conclusions Prevention and control measures adopted timely during the first wave were effective to limit Sars-CoV-2 spread within prison facilities. According to our findings, POs and PiP are population groups at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the importance of including prison settings within emergency preparedness plans. Key messages Stringent prevention and control measures when adopted timely were effective to protect detention facilities from Sars-CoV-2 spread. Our study, reporting the burden of COVID-19 epidemic experienced by prison of Lombardy, Italy, highlights the importance of including prison settings within emergency preparedness plans.

Hepatology ; 72(1 SUPPL):607A-608A, 2020.
Article in English | EMBASE | ID: covidwho-986099


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.