A SYSTEMATIC REVIEW OF HEPATITIS B AND C TESTING IN THE COUNTRIES OF THE WHO EUROPEAN REGION

Transcription

1 A SYSTEMATIC REVIEW OF HEPATITIS B AND C TESTING IN THE COUNTRIES OF THE WHO EUROPEAN REGION Jeffrey V. Lazarus* 1, Ida Sperle1, Jürgen K. Rockstroh2, Alexander Spina3, Lucas Wiessing4 1CHIP, Rigshospitalet, University of Copenhagen, Copenhagen Oe, Denmark, 2Department of Medicine I, University Hospital Bonn, Bonn, Germany, 3Centre for Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria, 4European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal Background and Aims: Growing awareness of the threat posed by hepatitis B and C has been accompanied by important biomedical advances in their treatment. However, in Europe as elsewhere, there is the potential for hepatitis drugs to be greatly underutilised because many people who might benefit from them are undiagnosed. We reviewed scientific studies reporting hepatitis B and C testing as a step toward informing public health strategies to reduce the number of individuals who remain undiagnosed. Methods: Using PRISMA criteria, we conducted a systematic review of the MEDLINE and EMBASE databases to identify original research studies reporting levels of hepatitis B and C testing in the 53 Member States of the WHO European Region. English-language peer-reviewed articles and conference abstracts published between January 2007 and June 2013 were included. Results: This review identified 154 studies from 28 (52.8%) of 53 countries. More than two-thirds of the studies (67.7%) were from six countries: Turkey, Germany, Italy, France, the Netherlands and the United Kingdom. The populations studied most frequently were people who use drugs (32 studies), health care patients (28) and populations tested for reasons relating to pregnancy or use of assisted reproductive technology (18) (Figure 1). Median testing uptake levels ranged from 100% for eight types of populations (Figure 1) to 79.9% for people born to HBsAg-positive mothers and 70.5% for current or former prison inmates. Four studies reported testing uptake of 75.0% or lower in people living with HIV, and six studies reported testing uptake of less than 50% in people who use drugs. The highest median HBsAg prevalence (14.9%) and HCV RNA prevalence (49.7%) were both found in people who use drugs. Conclusions: An evidence base on hepatitis B and C testing appears to be lacking in many European countries. The results indicate that some high-risk populations have been studied much more than others, but mostly only in a small number of countries. Since almost all studies utilised methodologies that required or encouraged study participants to undergo testing, high median testing uptake levels are not likely to be representative of overall testing uptake in most populations. Low testing uptake in some studies raises the question of whether key opportunities to identify infected individuals are being missed. Public health officials need much more comprehensive information in order to plan effective responses to hepatitis B and hepatitis C in Europe.

2 A Systematic Review of Viral Hepatitis B and C Testing in Europe: shortage of hepatitis screening studies across Europe/barrier to diagnosis, early treatment & prevention...apparent dearth of research on hepatitis B and C testing in many European countries could be hampering efforts to identify infected individuals...our review that there are crucial gaps in our knowledge on hepatitis B and C testing - we do not yet have enough information to plan effective public health responses in Europe...particularly concerned about the low numbers of published studies looking at migrants, prison inmates and men who have sex with men - all populations that might benefit greatly from targeted hepatitis testing interventions...current evidence base on hepatitis B and C testing appears to be lacking in many European countries...some high-risk populations have been studied much more than others, but mostly only in a small number of countries...viruses that affect the liver, such as hepatitis B and C, can cause real problems if not identified and treated early. We need to raise awareness of the threat posed by these viruses and actively encourage testing across Europe. This is not only vital to diagnosis and treatment but also to prevention - to stopping the viruses spreading through populations and generations to come." From Jules: this same problem exists in the US as well, there is very little federal commitment to HCV screening. As we experienced in HIV in the USA a large federal commitment along with funding to HIV screening was crucial to identifying people with HIV and linking them to care and treatment, and even with a federal commitment in the US to HIV screening with millions of dollars there are difficult barriers to identifying HIV+ individuals and successfully linking them to care & to engage patients successfully, and to retain them in care and successful treatment. HCV could be much simpler because there is a cure that is time-limited therapy/only 12 or 24 duration of therapy with up to 100% cure rates with current HCV treatments & more potent & effective treatments are in development. The federal govt has not provided anywhere near the commitment needed to address this problem. We could in theory eliminate HCV because it is easily treatable & curable but without a strong federal commitment we cannot "Test & Treat" as we do in HIV. The drugmakers with therapies currently on the market have recently cut their prices by 50%, but public Medicaid & private commercial payers refuse to budge on their harsh restrictions to access to therapy along with a lack of a federal commitment to address this problem as well as addressing HCV screening. The US Congress recently committed $150 million to the VA for HCV care & treatment indicating that when the politics are right they can & will make a commitment; the drugmakers provided a 50% price discount to the VA & Congress provided this large amount of funding. The overall political environment surrounding HCV is not one that reflects a strong uniform drive to succeed, the elements for such are lacking. It's clear this was a political decision because Congress did not want to look as though they were not supporting vets in this climate where vets were being mistreated. But obviously the White House & Congress are not convinced that investing in HCV elimination to the broader US is a politically worthwhile commitment. That's it, politicians respond when it is politically convenient and HCV in the US is not politically moving enough. Reported by Jules Levin EASL 2015 April Vienna Austria Lazarus JV,1 Sperle I,1 Duffell EF,2 Spina A,3 Rockstroh J,4 Wiessing L5 on behalf of the HIV in Europe Initiative (1) CHIP, Centre for Health and Infectious Disease Research, Rigshospitalet, University of Copenhagen, Denmark (2) European Centre for Disease Prevention and Control, Stockholm, Sweden (3) Centre for Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria (4) Department of Medicine I, University Hospital Bonn, Bonn, Germany (5) European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal EASL Press Release: Researchers highlight need for better evidence to guide European efforts to

3 increase hepatitis B and C testing Review presented at The International Liver CongressTM 2015 documents lack of information about hepatitis B and C testing in many countries April 25, 2015, Vienna, Austria: The apparent dearth of research on hepatitis B and C testing in many European countries could be hampering efforts to identify infected individuals, according to results from a comprehensive review of 136 studies presented today at The International Liver CongressTM The systematic review concluded that the current evidence base on hepatitis B and C testing appears to be lacking in many European countries. At present it is informed primarily by published articles and conference abstracts from just 6 out of 53 member countries of the World Health Organization (WHO) European Region: Turkey, Germany, Italy, France, the Netherlands and the United Kingdom. The results indicate that some high-risk populations have been studied much more than others, but mostly only in a small number of countries. The results also appear to show high median testing uptake levels across Europe. However, since almost all of the studies used methodologies that required or encouraged study participants to undergo testing, high median testing uptake levels are not likely to be representative of the overall testing uptake in most populations. "It's clear from our review that there are crucial gaps in our knowledge on hepatitis B and C testing - we do not yet have enough information to plan effective public health responses in Europe," commented Professor Jeffrey Lazarus, Professor of International Health Systems at Copenhagen University, Denmark. "Our research team is particularly concerned about the low numbers of published studies looking at migrants, prison inmates and men who have sex with men - all populations that might benefit greatly from targeted hepatitis testing interventions." Professor Tom Hemming Karlsen, Scientific Committee Member, European Association for the Study of the Liver, added: "Viruses that affect the liver, such as hepatitis B and C, can cause real problems if not identified and treated early. We need to raise awareness of the threat posed by these viruses and actively encourage testing across Europe. This is not only vital to diagnosis and treatment but also to prevention - to stopping the viruses spreading through populations and generations to come."

4

5

6

7

8

9

10

11