Overall, these recommendations aim to define a comprehensive testing strategy for chronic viral infections, emphasizing both targeted screening and mass screening and considering jointly HBV, HCV and HIV.
Background
Injecting drug use is a major driver of hepatitis C virus (HCV) spread worldwide, and the World Health Organization (WHO) has identified people who inject drugs (PWID) as a key population to target for HCV screening and care. Point-of-care (POC) hepatitis C tests and dried blood spot (DBS) sampling offer benefits for the management of patients with HCV infection by increasing HCV testing and linkage to care in different nonclinical settings. The aims of this prospective study were to evaluate the feasibility and the acceptability of use HCV ribonucleic acid (RNA) POC and fingerstick DBS testing in social-medical risk-reduction centers and to describe the cascade of care among PWID in France.
Methods
Between June 2018 and February 2019, 89 consecutive HCV-seropositive PWID attending 2 drug treatment services and 1 supervised consumption room in inner Paris were invited to participate in further evaluation, undergoing a clinical review with a liver assessment and blood tests including fingerstick capillary whole blood POC HCV RNA testing and fingerstick DBS sampling.
Results
Of the 89 participants enrolled, HCV RNA was detected in 34 (38.6%) participants. Fingerstick whole blood POC RNA testing and HCV RNA detection from DBS sample were feasible and acceptable among PWID with no major difference in terms of HCV RNA detection rate. Overall, 16 participants received pan-genotypic antiviral treatment. The proportion of PWID with sustained virologic response at 12 weeks was 81.2%, with data for 3 patients still pending.
Conclusions
One-step screening strategy based on the detection of HCV RNA would engage people in care for treatment scale-up and HCV elimination.
Delayed presentation to care among HIV-infected individuals continued to be frequent in France. Migrants are at high risk for late presentation. This cross-sectional study investigated barriers to HIV testing in the specific population of men from sub-Saharan Africa living in four migrant worker hostels in Paris, France. Factors associated with never having been tested for HIV were examined using logistic regression. In all, 550 men participated, coming mainly from Mali and Senegal, with 31 % having lived in France for less than 5 years, and 25 % without any health insurance. Only 37 % have ever been tested for HIV. Not having health insurance was the main risk factor for never-testing [adjusted odds ratio (aOR) 2.4; 95 % confidence interval (CI) 1.4-4.0]. Despite free and anonymous HIV testing available at dedicated public screening centers, 63 % of men living in migrant worker hostels had never been tested for HIV.
impact of closing the gap in vaccination coverage among older people in Germany. Methods: We developed a spreadsheet model to estimate the additional excess outcomes (primary care physician consultations, hospitalizations, and deaths) that could be prevented in the age group $60 years when achieving the WHO/EU coverage target of 75% compared to the current coverage of 38%. The average excess outcome rates we used in our model were based on official influenza surveillance reports from Germany. The efficacy estimate for influenza vaccination in the elderly population (59%) was taken from a meta-analysis. In sensitivity analysis, we used excess outcome rates from the UK to address potential underestimation of the German disease burden estimates. Results: When using epidemiological data from Germany, additional 170,000 physician visits, 3,000 hospitalizations, and 1,500 deaths could be prevented in an average season due to an increase in vaccination coverage. The estimated prevented disease burden increased considerably when using outcome rates from the UK. In the scenario using UK data, the number of additional hospital stays avoided ranged from 5,500 to almost 16,000, and saved lives due to the increase in vaccination coverage summed up to almost 7,000. Conclusions: An increase in vaccination coverage from 38% to 75% in the elderly population would lead to a significant reduction in influenza-associated public health burden in Germany. The comparison of results using data from Germany versus data from the UK suggests that the true impact might be underestimated when applying German excess hospitalization and mortality rates.
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