1887
Surveillance Open Access
Like 0

Abstract

Background

The World Health Organization European Action Plan 2020 targets for the elimination of viral hepatitis are that > 75% of eligible individuals with chronic hepatitis B (HBV) or hepatitis C (HCV) are treated, of whom > 90% achieve viral suppression.

Aim

To report the results from a pilot sentinel surveillance to monitor chronic HBV and HCV treatment uptake and outcomes in 2019.

Methods

We undertook retrospective enhanced data collection on patients with a confirmed chronic HBV or HCV infection presenting at one of seven clinics in three countries (Croatia, Romania and Spain) for the first time between 1 January 2019 and 30 June 2019. Clinical records were reviewed from date of first attendance to 31 December 2019 and data on sociodemographics, clinical history, laboratory results, treatment and treatment outcomes were collected. Treatment eligibility, uptake and case outcome were assessed.

Results

Of 229 individuals with chronic HBV infection, treatment status was reported for 203 (89%). Of the 80 individuals reported as eligible for treatment, 51% (41/80) were treated of whom 89% (33/37) had achieved viral suppression. Of 240 individuals with chronic HCV infection, treatment status was reported for 231 (96%). Of 231 eligible individuals, 77% (179/231) were treated, the majority of whom had received direct acting antivirals (99%, 174/176) and had achieved sustained virological response (98%, 165/169).

Conclusion

Treatment targets for global elimination were missed for HBV but not for HCV. A wider European implementation of sentinel surveillance with a representative sample of sites could help monitor progress towards achieving hepatitis control targets.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.6.2200184
2023-02-09
2024-07-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.6.2200184
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/6/eurosurv-28-6-1.html?itemId=/content/10.2807/1560-7917.ES.2023.28.6.2200184&mimeType=html&fmt=ahah

References

  1. Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593-608.  https://doi.org/10.1016/j.jhep.2012.12.005  PMID: 23419824 
  2. Dultz G, Zeuzem S, Hepatitis C, Hepatitis C. Virus: A European Perspective. Gastroenterol Clin North Am. 2015;44(4):807-24.  https://doi.org/10.1016/j.gtc.2015.07.008  PMID: 26600221 
  3. World Health Organization (WHO). Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 2016-2021: actions for impact. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240027077
  4. Hofstraat SHI, Falla AM, Duffell EF, Hahné SJM, Amato-Gauci AJ, Veldhuijzen IK, et al. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect. 2017;145(14):2873-85.  https://doi.org/10.1017/S0950268817001947  PMID: 28891457 
  5. Mårdh O, Quinten C, Amato-Gauci AJ, Duffell E. Mortality from liver diseases attributable to hepatitis B and C in the EU/EEA - descriptive analysis and estimation of 2015 baseline. Infect Dis (Lond). 2020;52(9):625-37.  https://doi.org/10.1080/23744235.2020.1766104  PMID: 32644030 
  6. World Health Organization (WHO). Combating Hepatitis B and C to reach elimination by 2030. Geneva: WHO; 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/206453/WHO_HIV_2016.04_eng.pdf?sequence=1&isAllowed=y (Accessed 12 December 2021)
  7. World Health Organization Regional Office for Europe (WHO). Action plan for the health sector response to viral hepatitis in the WHO European Region. Copenhagen: WHO Regional Office for Europe. 2017. Available from: https://www.euro.who.int/__data/assets/pdf_file/0008/357236/Hepatitis-9789289052870-eng.pdf
  8. World Health Organization (WHO). Global health sector strategy on viral hepatitis, 2016-2021: Towards ending viral hepatitis. Geneva: WHO; 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf?sequence=1&isAllowed=y (Accessed 12 December 2021)
  9. Zopf S, Kremer AE, Neurath MF, Siebler J. Advances in hepatitis C therapy: What is the current state - what come’s next? World J Hepatol. 2016;8(3):139-47.  https://doi.org/10.4254/wjh.v8.i3.139  PMID: 26839638 
  10. World Health Organization (WHO). (2015). Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Geneva: WHO; 2015. Available from: https://www.who.int/publications/i/item/9789241549059
  11. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388(10049):1081-8.  https://doi.org/10.1016/S0140-6736(16)30579-7  PMID: 27394647 
  12. Zelenev A, Li J, Shea P, Hecht R, Altice FL. Modeling Combination HCV Treatment and Prevention Strategies in a Network of People Who Inject Drugs in the USA. Clin Infect Dis. 2020;72(5):755-63.  https://doi.org/10.1093/cid/ciaa142  PMID: 32060534 
  13. European Centre for Disease Prevention and Control (ECDC). Hepatitis B. Annual epidemiological report for 2019. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/AER-Hepatitis-B-2019.pdf
  14. European Centre for Disease Prevention and Control (ECDC). Hepatitis C. Annual epidemiological report for 2019. Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/AER-Hepatitis-C-2019.pdf
  15. European Centre for Disease Prevention and Control (ECDC). Monitoring the responses to hepatitis B and C epidemics in EU/EEA Member States, 2019. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/monitoring-responses-hepatitis-b-and-c-epidemics-eueea-member-states-2019
  16. European Commission. Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. L 170/1. Official Journal of the European Union. 6 Jul 2018. Available from: http://data.europa.eu/eli/dec_impl/2018/945/oj
  17. Pawlotsky J-M, Negro F, Aghemo A, Berenguer M, Dalgard O, Dusheiko G, et al. Electronic address: [email protected]; Clinical Practice Guidelines Panel: Chair; EASL Governing Board representative; Panel members. EASL recommendations on treatment of hepatitis C: Final update of the series. J Hepatol. 2020;73(5):1170-218.  https://doi.org/10.1016/j.jhep.2020.08.018  PMID: 32956768 
  18. Lampertico P, Agarwal K, Berg T, Buti M, Janssen HLA, Papatheodoridis G, et al. Electronic address: [email protected]; European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-98.  https://doi.org/10.1016/j.jhep.2017.03.021  PMID: 28427875 
  19. Epiconcept. Voozanoo: On-line questionnaire, investigations and information systems for public health. [Accessed 1 Feb 2023]. Available from: https://portal.voozanoo.net/index.php
  20. Mauss S, Pol S, Buti M, Duffell E, Gore C, Lazarus JV, et al. European consensus working group on late presentation for Viral Hepatitis Care. Late presentation of chronic viral hepatitis for medical care: a consensus definition. BMC Med. 2017;15(1):92.  https://doi.org/10.1186/s12916-017-0856-y  PMID: 28464883 
  21. Hutin Y, Nasrullah M, Easterbrook P, Nguimfack BD, Burrone E, Averhoff F, et al. Access to Treatment for Hepatitis B Virus Infection - Worldwide, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(28):773-7.  https://doi.org/10.15585/mmwr.mm6728a2  PMID: 30025413 
  22. Tang E, Liu B, Bhuket T, Wong RJ. Low Rates of Linkage and Retention Into Care Among Patients With Chronic HBV Infection. Clin Gastroenterol Hepatol. 2019;17(9):1909-11.  https://doi.org/10.1016/j.cgh.2018.10.003 
  23. Zhou K, Fitzpatrick T, Walsh N, Kim JY, Chou R, Lackey M, et al. Interventions to optimise the care continuum for chronic viral hepatitis: a systematic review and meta-analyses. Lancet Infect Dis. 2016;16(12):1409-22.  https://doi.org/10.1016/S1473-3099(16)30208-0  PMID: 27615026 
  24. Nguyen NH, Nguyen V, Trinh HN, Lin B, Nguyen MH. Treatment eligibility of patients with chronic hepatitis B initially ineligible for therapy. Clin Gastroenterol Hepatol. 2013;11(5):565-71.  https://doi.org/10.1016/j.cgh.2012.12.028  PMID: 23333662 
  25. Lok AS, McMahon BJ, Brown RS Jr, Wong JB, Ahmed AT, Farah W, et al. Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis. Hepatology. 2016;63(1):284-306.  https://doi.org/10.1002/hep.28280  PMID: 26566246 
  26. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA. Elimination barometer on viral hepatitis among people who inject drugs in Europe. Table 9. Lisbon: EMCDDA. [Accessed: 5 Nov 2021]. Available from: https://www.emcdda.europa.eu/publications/html/viral-hepatitis-elimination-barometer_en#overviewTable
  27. Carrat F, Fontaine H, Dorival C, Simony M, Diallo A, Hezode C, et al. French ANRS CO22 Hepather cohort. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet. 2019;393(10179):1453-64.  https://doi.org/10.1016/S0140-6736(18)32111-1  PMID: 30765123 
  28. Kondili LA, Vella S, PITER Collaborating Group. PITER: An ongoing nationwide study on the real-life impact of direct acting antiviral based treatment for chronic hepatitis C in Italy. Dig Liver Dis. 2015;47(9):741-3.  https://doi.org/10.1016/j.dld.2015.05.022  PMID: 26138800 
  29. Sanna A, Le Strat Y, Roudot-Thoraval F, Deuffic Burban S, Carrieri P, Delarocque-Astagneau E, et al. Severe liver disease related to chronic hepatitis C virus infection in treatment-naive patients: epidemiological characteristics and associated factors at first expert centre visit, France, 2000 to 2007 and 2010 to 2014. Euro Surveill. 2017;22(30):30582.  https://doi.org/10.2807/1560-7917.ES.2017.22.30.30582  PMID: 28797326 
  30. Simmons R, Ireland G, Irving W, Hickman M, Sabin C, Ijaz S, et al. Establishing the cascade of care for hepatitis C in England-benchmarking to monitor impact of direct acting antivirals. J Viral Hepat. 2018;25(5):482-90.  https://doi.org/10.1111/jvh.12844  PMID: 29239130 
  31. Brouard C, Boussac-Zarebska M, Silvain C, Durand J, de Lédinghen V, Pillonel J, et al. Rapid and large-scale implementation of HCV treatment advances in France, 2007-2015. BMC Infect Dis. 2017;17(1):784.  https://doi.org/10.1186/s12879-017-2889-4  PMID: 29262788 
  32. Lattimore S, Irving W, Collins S, Penman C, Ramsay M, Collaboration for the Sentinel Surveillance of Blood-Borne Virus Testing. Using surveillance data to determine treatment rates and outcomes for patients with chronic hepatitis C virus infection. Hepatology. 2014;59(4):1343-50.  https://doi.org/10.1002/hep.26926  PMID: 24214920 
  33. MacLachlan JH, Romero N, Higgins N, Coutts R, Chan R, Stephens N, et al. Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance. Aust N Z J Public Health. 2020;44(1):59-64.  https://doi.org/10.1111/1753-6405.12934  PMID: 31535439 
  34. Radley A, Robinson E, Aspinall EJ, Angus K, Tan L, Dillon JF. A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments. BMC Health Serv Res. 2019;19(1):765.  https://doi.org/10.1186/s12913-019-4635-7  PMID: 31660966 
  35. Surey J, Menezes D, Francis M, Gibbons J, Sultan B, Miah A, et al. From peer-based to peer-led: redefining the role of peers across the hepatitis C care pathway: HepCare Europe. J Antimicrob Chemother. 2019;74(Suppl 5):v17-23.  https://doi.org/10.1093/jac/dkz452  PMID: 31782500 
/content/10.2807/1560-7917.ES.2023.28.6.2200184
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error