Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant

Background: We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. Methods: The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. Results: The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. Conclusions: Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.This work was funded by grant Ref. no. GLD14-00279 from the GILEAD Fellowship Programme (Spain) and by the Spanish AIDS Research Network (RD16/0025/0017, RD16/0025/0018) that is included in the Spanish I+D+I Plan and is co-financed by ISCIII-Subdirección General de Evaluacion and European Funding for Regional Development (FEDER).S

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Costos de atención médica atribuibles al tabaquismo en el IMSS, Morelos

Objetivo. Estimar los costos de atención médica en el Instituto Mexicano del Seguro Social (IMSS), Delegación Morelos, de las enfermedades mayores atribuibles al consumo de tabaco. Materiales y métodos. Las estimaciones de costos se realizaron desde la perspectiva del proveedor utilizando la metodología de costeo de enfermedad. Un panel de expertos multidisciplinario caracterizó la atención médica, en términos de la frecuencia de utilización de servicios en el primer y segundo niveles de atención, considerando el grado de severidad de la enfermedad. Los costos unitarios se estimaron en pesos mexicanos del 2001. Para estimar los costos atribuibles al tabaquismo se utilizó la fracción atribuible al consumo de tabaco para cada enfermedad (FA). Resultados. Los costos promedio anuales de atención médica en el primer y segundo niveles de atención en la Delegación Morelos corresponden a 79 530 pesos para infarto agudo del miocardio (IAM), 73 303 pesos para enfermedad pulmonar obstructiva crónica (EPOC) y 102 215 pesos para cáncer de pulmón (CP). El costo total anual para la Delegación por estas tres enfermedades asciende a 147 millones 390 mil 688 pesos. Los costos atribuibles al consumo de tabaco corresponden a 124 millones de pesos, lo cual equivale a 7.3% del presupuesto anual de la Delegación. Conclusiones. Estos resultados confirman el alto costo de la atención médica en el IMSS correspondiente a las enfermedades atribuibles al consumo de tabaco. Se recomienda realizar este estudio en el plano nacional, de tal manera que los tomadores de decisiones tengan herramientas para fortalecer las políticas de control del tabaquismo en México

Costos de la atención médica atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social

Objetivo. Cuantificar el efecto de las enfermedades atribuibles al consumo de tabaco, en términos epidemiológicos (morbilidad) y económicos (costos de atención médica), en el Instituto Mexicano del Seguro Social (IMSS) a escala nacional. Material y métodos. Los costos de la atención médica se estimaron desde la perspectiva del proveedor y se empleó la metodología del costeo de enfermedad. A partir de una muestra de pacientes (n= 1 596) atendidos en las unidades médicas se estableció la frecuencia de utilización de servicios en los tres niveles de atención. Para cada enfermedad se consideraron costos promedio por paciente y costos totales de enfermedad, los cuales se mensuraron en pesos mexicanos de 2004. Se calculó la fracción atribuible al consumo de tabaco para cada enfermedad, misma que se usó para atribuir los costos al tabaco. Resultados. Los costos totales anuales de atención médica nacional corresponden a 7 114 millones para el infarto agudo del miocardio, 3 424 millones para la enfermedad vascular cerebral, 1 469 millones para la enfermedad pulmonar obstructiva crónica y 102 millones para el cáncer pulmonar. El costo total anual para el IMSS por estas cuatro enfermedades asciende a 12 100 millones de pesos. Los costos atribuibles al consumo de tabaco corresponden a 7 100 millones de pesos, lo cual equivale a 4.3% del gasto de operación de la institución en el año 2004. Conclusiones. Estos resultados confirman el elevado costo de la atención médica de las enfermedades atribuibles al consumo de tabaco en el IMSS y generan información de primera mano necesaria para impulsar las medidas de prevención en esa institución y reforzar las políticas de control del tabaquismo ya aplicadas en México

Violencia contra mujeres embarazadas entre las usuarias del Instituto Mexicano del Seguro Social: un estudio sobre determinantes, prevalencia y severidad

This paper presents the results of a survey conducted among 446 female users of the health services of IMSS in the state of Morelos and who were in their third term of pregnancy. The aim was found that prevalence of violence remained the same in both periods (around 15 per cent). In contrast, the severity of emotional violence did increase during pregnancy, as opposed to that of physical and sexual violence, wich remained the same. A logistic regression analysis showed that the variables that best predict violence during pregnancy are the number of children, alcohol consumption by the partner, partner’s experience of violence during childhood, and violence during the year prior to pregnancy.Se presentan los resultados de una encuesta entre 446 mujeres usuarias de los servicios de salud del Instituto Mexicano del Seguro Social (IMSS) en Morelos, que se encontraban en su tercer trimestre de embarazo. El objetivo era indagar si la violencia contra mujeres se incrementa durante el embarazo o si, por el contrario, disminuye. Se encontró que la prevalencia no varió en ambos periodos (aproximadamente 15 por ciento, en general). En cambio, la severidad de la violencia emocional se incrementó durante el embarazo, mientras que la de la violencia física y sexual se mantuvo constante. Un análisis de regresión logística mostró que las variables que mejor predicen la violencia durante el embarazo son el número de hijos, el consumo de alcohol por parte de la pareja, la historia de violencia en la infancia de la pareja y la existencia de violencia durante el año previo al embarazo

Costos de la atención médica atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social Health care costs attributable to tobacco consumption on a national level in the Mexican Social Security Institute

OBJETIVO: Cuantificar el efecto de las enfermedades atribuibles al consumo de tabaco, en términos epidemiológicos (morbilidad) y económicos (costos de atención médica), en el Instituto Mexicano del Seguro Social (IMSS) a escala nacional. MATERIAL Y MÉTODOS: Los costos de la atención médica se estimaron desde la perspectiva del proveedor y se empleó la metodología del costeo de enfermedad. A partir de una muestra de pacientes (n= 1 596) atendidos en las unidades médicas se estableció la frecuencia de utilización de servicios en los tres niveles de atención. Para cada enfermedad se consideraron costos promedio por paciente y costos totales de enfermedad, los cuales se mensuraron en pesos mexicanos de 2004. Se calculó la fracción atribuible al consumo de tabaco para cada enfermedad, misma que se usó para atribuir los costos al tabaco. RESULTADOS: Los costos totales anuales de atención médica nacional corresponden a 7 114 millones para el infarto agudo del miocardio, 3 424 millones para la enfermedad vascular cerebral, 1 469 millones para la enfermedad pulmonar obstructiva crónica y 102 millones para el cáncer pulmonar. El costo total anual para el IMSS por estas cuatro enfermedades asciende a 12 100 millones de pesos. Los costos atribuibles al consumo de tabaco corresponden a 7 100 millones de pesos, lo cual equivale a 4.3% del gasto de operación de la institución en el año 2004. CONCLUSIONES: Estos resultados confirman el elevado costo de la atención médica de las enfermedades atribuibles al consumo de tabaco en el IMSS y generan información de primera mano necesaria para impulsar las medidas de prevención en esa institución y reforzar las políticas de control del tabaquismo ya aplicadas en México.OBJECTIVE: To estimate the cost of medical care for the major diseases attributable to tobacco consumption at the IMSS. MATERIAL AND METODS: A cost of illness (COI) analysis was carried out from the perspective of the health provider. A random sample of clinical files (n= 1,596) was reviewed to estimate the human resources and medical supplies's utilization according to the health care facilities. The smoking attributable fraction (SAF) by disease was used to derive costs attributable to tobacco consumption. The unitary cost was valuated in 2004 Mexican pesos (MP). RESULTS: The estimated annual total cost of medical care was 7114 million MP for acute myocardial infarction (AMI); 3424 million MP for Cerebrovascular Disease, 1469 million MP for chronic obstructive pulmonary disease (COPD) and 102 million MP for lung cancer (LC). The annual total cost of medical care for IMSS was 12100 million MP. The total annual cost of medical care attributable to tobacco consumption corresponds to 7100 million MP, which is equivalent to 4.3% of the annual expenditures of the IMSS during 2004. CONCLUSIONS: These results confirm the high medical costs associated with smoking. This information would be used to reinforce the tobacco control preventive actions at IMSS and support decision-makers in strengthening public policies to control tobacco use in Mexico

Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant

Background: We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. Methods: The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. Results: The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. Conclusions: Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.This work was funded by grant Ref. no. GLD14-00279 from the GILEAD Fellowship Programme (Spain) and by the Spanish AIDS Research Network (RD16/0025/0017, RD16/0025/0018) that is included in the Spanish I+D+I Plan and is co-financed by ISCIII-Subdirección General de Evaluacion and European Funding for Regional Development (FEDER).S