214 research outputs found
A call for health systems to monitor the health-related quality of life of people living with HIV
Introduction: The World Health Organization's (WHO's) new global health strategy on HIV represents a major step toward a broader conceptualization of HIV care. It recognizes the importance of addressing chronic care more fully and-for the first time ever-the health-related quality of life (HRQoL) of people living with HIV (PLHIV).Methods: A thorough literature review was conducted in order to analyse how the WHO strategy on HIV for 2022-2030 addresses the monitoring of the HRQoL of PLHIV for the next decade and compared it to that of other countries and health authorities.Results: Unlike for other issues, the strategy does not include quantitative targets for 2030, thus falling short of committing to monitoring global progress in improving the long-term well-being of PLHIV.Conclusions: We urge national health systems not to wait for WHO to lead on this issue. Seeking good HRQoL outcomes for PLHIV can confer far-reaching benefits on health systems. The feasibility of monitoring population-level HRQoL has been demonstrated through the use of simple tools like patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Many countries can already set HRQoL monitoring targets, similar to those presented in this viewpoint, while we work toward an agreed minimum metric for use by all countries
Hepatitis C services at harm reduction centres in the European Union: a 28-country survey
Background: In the context of the WHO’s 2016 Viral Hepatitis Strategy and the introduction of treatment that
can cure more than 95% of cases with hepatitis C virus (HCV) infection, the European Joint Action on HIV
and Co-infection Prevention and Harm Reduction (HA-REACT) undertook a study in the member states of the
European Union (EU). It aimed to determine service providers’ understanding of the current services in their
respective countries and the barriers experienced by PWID in accessing HCV testing, care and treatment
services in their country.
Methods: In 2017, 38 purposively selected harm reduction service providers completed a 26-item Englishlanguage online survey addressing the availability, accessibility and funding of HCV services at harm reduction
centres. HCV-related data and reported findings were extracted by country or by responding organization.
Results: Responses were received from all EU member states. Respondents from 23 countries reported that
HCV tests are offered by harm reduction services in their countries, and eight countries reported that
addiction specialists in their countries are able to prescribe HCV therapy. Almost half of the respondents
(45%) said that their respective organizations had established referral systems with centres providing HCV
treatment.
Conclusions: Not all EU member states have harm reduction services that provide HCV tests, and many do
not have established referral systems with treatment providers. Moreover, the inability of addiction specialists
to prescribe HCV treatment points to missed opportunities to make treatment more accessible. Further,
discrepancies were noted between the available HCV services and stakeholders’ knowledge about their
availability
Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review
Chronic viral hepatitis infection affects an estimated 325 million people globally. People who initiate treatment after significant disease progression face increased risk of severe liver complications and death. Data are scarce on the characteristics and risk factors of people who present late to care in Spain and globally. Data were collected from January 2018 to December 2019 to report late presentation (LP) to specialist care at 11 large university hospitals in Spain to assess related risk factors using a multivariable logistic regression model. 2290 (CHB = 505, CHC = 1785) patients were analysed, with 581 (25.2%) presenting late. Hepatitis C patients more frequently reported LP compared to hepatitis B patients (28.1% vs 15.0%; p < 0.001). Older age (p < 0.001), being male
(p < 0.001), being Spanish‑born (p < 0.001), and having an unknown origin of referral (p = 0.08) were associated with a higher likelihood of LP. Advanced liver disease was identified in 533 (23%) patients and late‑stage liver disease in 124 (5.4%). LP, including with irreversible liver damage, to viral hepatitis
specialist care is frequent in Spain, despite being a country with unrestricted treatment access. Initiatives to reduce LP should specifically target men, older individuals, foreign‑born populations for CHB, and Spanish nationals for CHC
Health Outcomes for Clients of Needle and Syringe Programs in Prisons
High levels of drug dependence have been observed in the
prison population globally, and the sharing of injecting drug
equipment in prisons has contributed to higher prevalence of
bloodborne diseases in prisoners than in the general population.
Few prison needle and syringe programs (PNSPs) exist. We
conducted a systematic review to assess evidence regarding
health outcomes of PNSPs. We searched peer-reviewed databases
for data relating to needle and syringe programs in prisons. The
search methodology was conducted in accordance with accepted
guidelines. Five studies met review inclusion criteria, and all
presented evidence associating PNSPs with one or more health
benefits, but the strength of the evidence was low. The outcomes
for which the studies collectively demonstrated the strongest
evidence were prevention of human immunodeficiency virus and
viral hepatitis. Few negative consequences from PNSPs were
observed, consistent with previous evidence assessments. More
research is needed on PNSP effectiveness, and innovative study
designs are needed to overcome methodological limitations of
previous research. Until stronger evidence becomes available,
policymakers are urged to recognize that not implementing PNSPs
has the potential to cause considerable harm, in light of what
is currently known about the risks and benefits of needle and
syringe programs and PNSPs and about the high prevalence of
human immunodeficiency virus and viral hepatitis in prisons
Integrating social nutrition principles into the treatment of steatotic liver disease
Current treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) focuses on adjusting patients’ lifestyles, including promoting weight loss and physical activity. Here, we suggest adopting a holistic preventive hepatology approach encompassing social nutrition, social prescribing and broader societal changes to facilitate individuals’ engagement with behavioural modifications
Long-term success for people living with HIV: A framework to guide practice
Objectives: In recent decades, the needs of people living with HIV have evolved as life expectancy has greatly improved. Now, a new definition of long-term success (LTS) is necessary to help address the multifaceted needs of all people living with HIV. Methods: We conducted a two-phase research programme to delineate the range of experiences of people living with HIV. The insights garnered from these research phases were explored in a series of expert-led workshops, which led to the development and refinement of the LTS framework. Results: The insights generated from the research phases identified a series of themes that form a part of LTS. These themes were subsequently incorporated into the LTS framework, which includes five outcome pillars: sustained undetectable viral load, minimal impact of treatment and clinical monitoring, optimized health-related quality of life, lifelong integration of healthcare, and freedom from stigma and discrimination. A series of supporting statements were also developed by the expert panel to help in the achievement of each of the LTS pillars. Conclusions: The LTS framework offers a comprehensive and person-centric approach that, if achieved, could help improve the long-term well-being of people living with HIV and support the LTS vision of 'every person living with HIV being able to live their best life'
Why we need to re-define long-term success for people living with HIV
: Over the past few decades, the life expectancy of people living with HIV has markedly improved due to the advances in HIV diagnosis, linkage to care, and treatment. However, with these advances, a new set of challenges has emerged that must be addressed to ensure the long-term well-being of people living with HIV. In this article, as part of a wider journal supplement, we explore the unmet needs and challenges across the HIV continuum of care and re-define what long-term success looks like to support the healthy ageing of all people affected by HIV
COVID-SCORE: A global survey to assess public perceptions of government responses to COVID-19 (COVID-SCORE-10)
BACKGROUND content: Understanding public
perceptions of government responses to COVID-19 may foster
improved public cooperation. Trust in government and population
risk of exposure may influence public perception of the
response. Other population-level characteristics, such as
country socio-economic development, COVID-19 morbidity and
mortality, and degree of democratic government, may influence
perception. - Label: METHODS AND FINDINGS content: We developed
a novel ten-item instrument that asks respondents to rate key
aspects of their government's response to the pandemic
(COVID-SCORE). We examined whether the results varied by gender,
age group, education level, and monthly income. We also examined
the internal and external validity of the index using
appropriate predefined variables. To test for dimensionality of
the results, we used a principal component analysis (PCA) for
the ten survey items. We found that Cronbach's alpha was 0.92
and that the first component of the PCA explained 60% of
variance with the remaining factors having eigenvalues below 1,
strongly indicating that the tool is both reliable and
unidimensional. Based on responses from 13,426 people randomly
selected from the general population in 19 countries, the mean
national scores ranged from 35.76 (Ecuador) to 80.48 (China) out
of a maximum of 100 points. Heterogeneity in responses was
observed across age, gender, education and income with the
greatest amount of heterogeneity observed between countries.
National scores correlated with respondents' reported levels of
trust in government and with country-level COVID-19 mortality
rates. - Label: CONCLUSIONS content: The COVID-SCORE survey
instrument demonstrated satisfactory validity. It may help
governments more effectively engage constituents in current and
future efforts to control COVID-19. Additional country-specific
assessment should be undertaken to measure trends over time and
the public perceptions of key aspects of government responses in
other countries
The Hep-CORE policy score: A European hepatitis C national policy implementation ranking based on patient organization data.
BACKGROUND content: New hepatitis C virus (HCV) treatments spurred the World Health Organization (WHO) in 2016 to adopt a strategy to eliminate HCV as a public health threat by 2030. To achieve this, key policies must be implemented. In the absence of monitoring mechanisms, this study aims to assess the extent of policy implementation from the perspective of liver patient groups. - Label: METHODS content: "Thirty liver patient organisations, each representing a country, were surveyed in October 2018 to assess implementation of HCV
policies in practice. Respondents received two sets of questions
based on: 1) WHO recommendations; and 2) validated data sources
verifying an existing policy in their country. Academic experts
selected key variables from each set for inclusion into policy
scores. The similarity scores were calculated for each set with
a multiple joint correspondence analysis. Proxy reference
countries were included as the baseline to contextualize
results. We extracted scores for each country and standardized
them from 0 to 10 (best)." - Label: RESULTS content: Twenty-five
countries responded. For the score based on WHO recommendations,
Bulgaria had the lowest score whereas five countries (Cyprus,
Netherlands, Portugal, Slovenia, and Sweden) had the highest
scores. For the verified policy score, a two-dimensional
solution was identified; first dimension scores pertained to
whether verified policies were in place and second dimension
scores pertained to the proportion of verified policies in-place
that were implemented. Spain, UK, and Sweden had high scores for
both dimensions. - Label: CONCLUSIONS content: Patient groups
reported that the European region is not on track to meet WHO
2030 HCV goals. More action should be taken to implement and
monitor HCV policies
- …