Cost-effectiveness of HBV and HCV screening strategies:a systematic review of existing modelling techniques

Introduction: Studies evaluating the cost-effectiveness of screening for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are generally heterogeneous in terms of risk groups, settings, screening intervention, outcomes and the economic modelling framework. It is therefore difficult to compare cost-effectiveness results between studies. This systematic review aims to summarise and critically assess existing economic models for HBV and HCV in order to identify the main methodological differences in modelling approaches. Methods: A structured search strategy was developed and a systematic review carried out. A critical assessment of the decision-analytic models was carried out according to the guidelines and framework developed for assessment of decision-analytic models in Health Technology Assessment of health care interventions. Results: The overall approach to analysing the cost-effectiveness of screening strategies was found to be broadly consistent for HBV and HCV. However, modelling parameters and related structure differed between models, producing different results. More recent publications performed better against a performance matrix, evaluating model components and methodology. Conclusion: When assessing screening strategies for HBV and HCV infection, the focus should be on more recent studies, which applied the latest treatment regimes, test methods and had better and more complete data on which to base their models. In addition to parameter selection and associated assumptions, careful consideration of dynamic versus static modelling is recommended. Future research may want to focus on these methodological issues. In addition, the ability to evaluate screening strategies for multiple infectious diseases, (HCV and HIV at the same time) might prove important for decision makers

Hepatitis a among men who have sex with men in Barcelona, 1989-2010: insufficient control and need for new approaches

<p>Abstract</p> <p>Background</p> <p>Men who have sex with men (MSM) are a known group at risk for hepatitis A and outbreaks among this group are frequent. In Barcelona, vaccination for MSM has been recommended since 1994. In 1998 a vaccination campaign among preadolescents was implemented and an immunization program in gay bathhouses began in 2004. Objective: to asses the incidence of hepatitis A in adults in Barcelona from 1989 to 2010 and to evaluate the outbreaks among MSM including all genotypes involved.</p> <p>Methods</p> <p>All cases of acute hepatitis A among young adults notified to the Public Health Agency of Barcelona from 1989 to 2010 were included for analyses. We calculated the annual incidence rate and the incidence ratio male-to-female (M:F) as a marker for MSM. Spearman's coefficient was used to evaluate trends. We also evaluated the outbreaks among MSM and compared their characteristics using Chi-squared and ANOVA test. Fragment amplification of the VP1/P2A region was used for genetic analysis.</p> <p>Results</p> <p>The median annual incidence for the period of study was 4.7/100000 among females and 11.7/100000 among males. The rate of hepatitis A for adult woman decreased over time (Spearman' coefficient = -0.63, <it>p </it>= 0.002), whereas there was no decrease for adult men (Spearman' coefficient = 0.097, <it>p </it>= 0.67). During the study period the M:F ratio increased (Spearman' coefficient = 0.73, <it>p </it>< 0.001).</p> <p>Three large outbreaks among MSM were detected. When comparing outbreaks, there was a decrease in the percentage of bathhouse users (from 47% to 19%, <it>p </it>= 0.0001) and sex workers (from 6.5% to 0%) while the percentage of HIV infected individuals did not change significantly (range: 21%-28%, <it>p </it>= 0.36). The isolated strains were closely related to those circulating in Europe.</p> <p>Conclusions</p> <p>Annual incidences remain high among MSM without tendency to decrease. More strategies which effectively reach the whole MSM community are needed.</p

Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review.

© 2015 Owiti et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Hepatitis B and C (HBV, HCV) infections are associated with high morbidity and mortality. Many countries with traditionally low prevalence (such as UK) are now planning interventions (screening, vaccination, and treatment) of high-risk immigrants from countries with high prevalence. This review aimed to synthesise the evidence on immigrants' knowledge of HBV and HCV that might influence the uptake of clinical interventions. The review was also used to inform the design and successful delivery of a randomised controlled trial of targeted screening and treatment. METHODS: Five databases (PubMed, CINHAL, SOCIOFILE, PsycINFO & Web of Science) were systematically searched, supplemented by reference tracking, searches of selected journals, and of relevant websites. We aimed to identify qualitative and quantitative studies that investigated knowledge of HBV and HCV among immigrants from high endemic areas to low endemic areas. Evidence, extracted according to a conceptual framework of Kleinman's explanatory model, was subjected to narrative synthesis. We adapted the PEN-3 model to categorise and analyse themes, and recommend strategies for interventions to influence help-seeking behaviour. RESULTS: We identified 51 publications including quantitative (n = 39), qualitative (n = 11), and mixed methods (n = 1) designs. Most of the quantitative studies included small samples and had heterogeneous methods and outcomes. The studies mainly concentrated on hepatitis B and ethnic groups of South East Asian immigrants residing in USA, Canada, and Australia. Many immigrants lacked adequate knowledge of aetiology, symptoms, transmission risk factors, prevention strategies, and treatment, of hepatitis HBV and HCV. Ethnicity, gender, better education, higher income, and English proficiency influenced variations in levels and forms of knowledge. CONCLUSION: Immigrants are vulnerable to HBV and HCV, and risk life-threatening complications from these infections because of poor knowledge and help-seeking behaviour. Primary studies in this area are extremely diverse and of variable quality precluding meta-analysis. Further research is needed outside North America and Australia

HCV co-infection in HIV positive population in British Columbia, Canada

<p>Abstract</p> <p>Background</p> <p>As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. This study used a population-based sample of HIV and HCV tested individuals to determine the prevalence of HIV/HCV co-infection, the sequence of virus diagnoses, and demographic and associated risk factors.</p> <p>Methods</p> <p>Positive cases of HIV were linked to the combined laboratory database (of negative and positive HCV antibody results) and HCV reported cases in British Columbia (BC).</p> <p>Results</p> <p>Of 4,598 HIV cases with personal identifiers, 3,219 (70%) were linked to the combined HCV database, 1,700 (53%) of these were anti-HCV positive. HCV was diagnosed first in 52% of co-infected cases (median time to HIV identification 3 1/2 years). HIV and HCV was diagnosed within a two week window in 26% of cases. Among individuals who were diagnosed with HIV infection at baseline, subsequent diagnoses of HCV infection was independently associated with: i) intravenous drug use (IDU) in males and females, Hazard Ratio (HR) = 6.64 (95% CI: 4.86-9.07) and 9.76 (95% CI: 5.76-16.54) respectively; ii) reported Aboriginal ethnicity in females HR = 2.09 (95% CI: 1.34-3.27) and iii) males not identified as men-who-have-sex-with-men (MSM), HR = 2.99 (95% CI: 2.09-4.27).</p> <p>Identification of HCV first compared to HIV first was independently associated with IDU in males and females OR = 2.83 (95% CI: 1.84-4.37) and 2.25 (95% CI: 1.15-4.39) respectively, but not Aboriginal ethnicity or MSM. HIV was identified first in 22%, with median time to HCV identification of 15 months;</p> <p>Conclusion</p> <p>The ability to link BC public health and laboratory HIV and HCV information provided a unique opportunity to explore demographic and risk factors associated with HIV/HCV co-infection. Over half of persons with HIV infection who were tested for HCV were anti-HCV positive; half of these had HCV diagnosed first with HIV identification a median 3.5 years later. This highlights the importance of public health follow-up and harm reduction measures for people identified with HCV to prevent subsequent HIV infection.</p

Trouble with Bleeding: Risk Factors for Acute Hepatitis C among HIV-Positive Gay Men from Germany—A Case-Control Study

OBJECTIVES: To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants. BACKGROUND: Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood. METHODS: Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection. RESULTS: 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding. CONCLUSIONS: Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding

PrEP-dossier : Pre Exposure Profylaxis for hiv-negative individuals in the Netherlands

In October 2016, the Minister for Health, Welfare and Sport requested advice from the Health Council of the Netherlands on the use of medication to prevent HIV infection (pre-exposure prophylaxis, or PrEP) in people with an increased risk of HIV. The National Institute for Public Health and the Environment (RIVM) compiled background information to support the Health Council of the Netherlands. Important points in this background information are: HIV continues to be a dangerous viral infection but can be regarded as a chronic disease, provided that it is discovered early on and properly treated. In these cases there is also a very small chance of the virus being transmitted to another individual. HIV transmission can be prevented by condom usage, regular HIV testing and prompt treatment of infection. PrEP is a new method of preventing HIV infection, which involves taking antiviral medication before sexual contact with a (possibly) HIV-positive individual. Healthcare providers determine who is eligible to use PrEP based on a professional guideline on the risk of HIV and sexual behaviour. PrEP is registered and available in the Netherlands, but the high costs of usage and associated healthcare are not covered by insurance. PrEP has been proven to be effective and safe when used properly. Compliance is essential, as is the associated healthcare: anyone using PrEP must be tested for HIV on a regular basis in order to promptly detect (resistant) HIV infections for which the medication is ineffective. Regular liver and kidney function tests are also required, and PrEP users should also undergo regular testing for other sexually transmitted diseases.De minister van VWS heeft in oktober 2016 aan de Gezondheidsraad advies gevraagd over het gebruik van medicijnen om hiv-infecties te voorkomen (Pre-Expositie Profylaxe, ofwel PrEP) bij personen met een verhoogd risico op hiv. Om de Gezondheidsraad te ondersteunen heeft het RIVM achtergrondinformatie bijeengebracht. Belangrijke punten daaruit zijn: Hiv blijft een gevaarlijke virusinfectie maar kan als een chronische ziekte beschouwd worden, mits het vroegtijdig wordt ontdekt en op een juiste wijze wordt behandeld. In deze gevallen is er ook een zeer beperkte kans dat het virus op een andere persoon wordt overgedragen. Besmettingen met hiv zijn te voorkomen door condoomgebruik, regelmatig testen op hiv en een snelle behandeling van een infectie. PrEP is een middel om een hiv-infectie te voorkomen. Dit middel wordt geslikt vóórdat seksueel contact plaatsvindt met een (mogelijk) met hiv geïnfecteerd persoon. Op basis van een professionele richtlijn over het risico op hiv en seksueel gedrag bepalen zorgverleners wie ervoor in aanmerking komt. PrEP is geregistreerd en beschikbaar in Nederland, maar de (hoge) kosten voor gebruik en zorg worden niet vergoed. PrEP is bewezen effectief en veilig als het goed gebruikt wordt. Therapietrouw is essentieel, net als de juiste zorg eromheen: de gebruiker van PrEP moet regelmatig getest worden op hiv om resistente hiv-infecties, waartegen het middel dus niet werkt, tijdig op te sporen. Daarnaast moet regelmatig worden gecontroleerd of lever en nieren nog goed functioneren. Verder moeten PrEP-gebruikers zich regelmatig op andere seksueel overdraagbare aandoeningen laten testen.Ministerie van VW

PrEP-dossier : Pre-Expositie Profylaxe voor hiv-negatieven in Nederland

In October 2016, the Minister for Health, Welfare and Sport requested advice from the Health Council of the Netherlands on the use of medication to prevent HIV infection (pre-exposure prophylaxis, or PrEP) in people with an increased risk of HIV. The National Institute for Public Health and the Environment (RIVM) compiled background information to support the Health Council of the Netherlands. Important points in this background information are: HIV continues to be a dangerous viral infection but can be regarded as a chronic disease, provided that it is discovered early on and properly treated. In these cases there is also a very small chance of the virus being transmitted to another individual. HIV transmission can be prevented by condom usage, regular HIV testing and prompt treatment of infection. PrEP is a new method of preventing HIV infection, which involves taking antiviral medication before sexual contact with a (possibly) HIV-positive individual. Healthcare providers determine who is eligible to use PrEP based on a professional guideline on the risk of HIV and sexual behaviour. PrEP is registered and available in the Netherlands, but the high costs of usage and associated healthcare are not covered by insurance. PrEP has been proven to be effective and safe when used properly. Compliance is essential, as is the associated healthcare: anyone using PrEP must be tested for HIV on a regular basis in order to promptly detect (resistant) HIV infections for which the medication is ineffective. Regular liver and kidney function tests are also required, and PrEP users should also undergo regular testing for other sexually transmitted diseases