Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

Abstract

Background & Aims: Despite the availability of effective therapies for hepatitis B (HBV) and C virus (HCV), only a minority of these patients receive treatment. We systematically reviewed published data on barriers to management for chronic HBV/HCV patients in Europe. Methods: Literature search to identify studies including adult patients with chronic HBV/HCV infection from European countries and data on barriers to treatment. Results: Twenty-five studies including 6253 chronic HBV and 19 014 HCV patients were identified, of which only two were from Eastern Europe. The mean rate of no treatment in HBV patients was 42% being higher in North-Western European countries than Italy (56% vs. 39%, P < 0.001). Immigrants represented the most common barrier to HBV treatment. The mean rate of no treatment in HCV RNA-positive patients was 57%, being highest in Romania (89%), intermediate in France (79%) and lower though still high in other European countries (52%, P < 0.001). The predominant barriers to HCV treatment were lack of financial resources in Romania and direct/indirect limitations of interferon-alfa and/or parenteral drug and alcohol abuse in other countries. The mean rate of no treatment was highest in HCV RNA-positive parenteral drug users (72%) and intermediate in those with HCV-HIV co-infection (64%). Conclusions: A substantial proportion of diagnosed chronic HBV and the majority of diagnosed HCV patients remain untreated. The rates and most importantly the reasons of barriers to treatment in chronic HBV/HCV patients vary widely among European countries supporting the need for country-specific national strategies, resource allocation and implementation of global management policies.Hepatitis B (HBV) and C viruses (HCV) are leading causes of chronic liver disease worldwide and responsible for 1.2-1.5 million deaths annually (1, 2). In particular in Europe, according to the estimations of the European Region of the World Health Organization, there are approximately 14 and 9 million people chronically infected with HBV and HCV and around 36 000 and 86 000 related deaths each year, respectively, with the number of deaths reported to be increasing (3).Over the last 15 years, the efficacy of the therapeutic options for chronic HBV and HCV infections has dramatically improved. Practically all chronic HBV infection can now achieve at least on-therapy virological remission which is associated with improved liver histology and often even reversion of pre-existing histological cirrhosis, reduction in need for liver transplantation and eventually improved survival (4, 5). In patients with chronic HCV infection, sustained virological response, which is equivalent to viral eradication and has been shown to improve survival (6, 7), can be currently achieved in the majority of cases without contraindication for interferon-alfa-based therapies (8, 9), while emerging and future treatment options are expected to further improve the sustained virological response rates to over 90-95% extending the treatment indications ...

Hepatitis B knowledge and associated factors among people with chronic hepatitis B

“…The proportion of untreated people with CHB in Europe ranges between 37% and 66%. 7 One explanation for the under-diagnosis of CHB and poor access to clinical care is a lack of knowledge about the virus among people with, or at greater risk of, hepatitis B infection. 1 This hypothesis is supported by improvements in healthcare-seeking behaviour among people with CHB following educational interventions.…”

Public health impact of comprehensive hepatitis C screening and treatment in the French baby-boomer population

“…Although the impact of other all-oral regimens aside from 3D ± RBV approved for the treatment of HCV genotype 1 was not explicitly tested in the model, results are not greatly sensitive to SVR rates and, hence, not expected to change substantively. Finally, our analysis did not take into account the fact that barriers to HCV screening and treatment have been consistently reported 53 . Assessing the impacts of barriers to care on outcomes may lead to identification of particular areas for improvement to better inform HCV policy.…”

Seguimento clínico de pacientes identificados como portadores do vírus da hepatite C através da doação de sangue

“…Enquanto que na Europa, conforme recente revisão, cerca de 57% dos indivíduos infectados pela hepatite C não recebem tratamento específico 23 .…”

“…Nos Estados Unidos da América, em recente revisão sobre a cascata de cuidados e tratamento da infecção crônica pelo VHC, foram identificadas grandes lacunas e barreiras ao longo da linha de atendimento desses pacientes e o principal obstáculo identificado parece ser o não reconhecimento do status de portador de hepatite C, pela população afetada 69 . Nessa revisão, porém, não foi possível avaliar se algumas características como sexo, raça, condição socioeconômica, uso de drogas injetáveis e coinfecção pelo HIV foram associadas às barreiras encontradas ao longo da cascata de cuidados para a hepatite C Já na Europa, entre as principais barreiras descritas para o cuidado clínico desses pacientes, descrevem-se a falta de recursos financeiros e dificuldades de acesso aos serviços de saúde nos países do Leste Europeu, enquanto que o uso de drogas ilícitas e o consumo abusivo de bebidas alcóolicas são as causas mais frequentemente relatadas nos demais países europeus 23 .…”

“…Além disso, o custo dos medicamentos envolvidos pode representar importante obstáculo ao tratamento dessa patologia 22,23,24 .…”