Screening strategies for Hepatitis C Virus elimination in Italy

The World Health Organization (WHO) targets for eliminating HCV by 2030 may be overambitious for many high‐income countries. Recent analyses (ie, data from 2017 to 2019) show that only 11 countries are on track for meeting WHO’s elimination targets. For a country to be truly on track, it is important that the majority of infected individuals be identified and treated. There is still a need for country and population‐specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost‐effectiveness and sustainability and support an evidence‐based policy for HCV elimination. Any health policy model is affected by the diversity and quality of the available data and by gaps in data. Given the differences among countries, comparing progress based on fixed global targets will not necessarily be suitable in the same measure for each country. In a recent document, the European Collaborators of Polaris Observatory provide insight into the limitations of the current WHO targets. The absolute targets identified by each country in accordance with the measures set by WHO would be essential in reaching the HCV elimination. All analytic models to assess the progress towards HCV elimination are based on projections to 2030 not including the impact of the COVID‐19 pandemic on hepatitis‐related services. With specific regard to the achievement of WHO hepatitis elimination goals, all measures that will be put in place during and after COVID‐19 pandemic could be transferred in increasing diagnosis and linkage to care of people with hepatitis.

Section: Moving From Theory To Practice: Country and Population‐speci...mentioning

confidence: 99%

Absolute targets for HCV elimination and national health policy paradigms: Foreseeing future requirements

Kondili

Craxı̀

Aghemo

2021

“…7 It has been previously estimated that assuming DAA treatment rates remain stable as they were during the year 2019, the WHO targets would not be achievable in Italy. 8 An experimental two-year free-of-charge screening program has now been approved by law in Italy, 6,[9][10][11] although it has not been not fully implemented. 6,12 The decrease in HCV treatment rate started in Italy before the Coronavirus disease 2019 (COVID- 19) pandemic and continued during the pandemic, persisting up to date.…”

Section: Introductionmentioning

confidence: 99%

“…Without an effective screening, the number of diagnosed people was estimated to run out by 2025 leaving a high HCV infection and disease burden in Italy 7 . It has been previously estimated that assuming DAA treatment rates remain stable as they were during the year 2019, the WHO targets would not be achievable in Italy 8 . An experimental two‐year free‐of‐charge screening program has now been approved by law in Italy, 6,9–11 although it has not been not fully implemented 6,12 .…”

Section: Introductionmentioning

confidence: 99%

Forecasting the long‐term impact of COVID‐19 on hepatitis C elimination plans in Italy: A mathematical modelling approach

Kondili,

Andreoni,

Aghemo

et al. 2023

BackgroundItaly has a high HCV prevalence, and despite the approval of a dedicated fund for ‘Experimental screening’ for 2 years, screening has not been fully implemented. We aimed to evaluate the long‐term impact of the persisting delay in HCV elimination after the Coronavirus disease 2019 (COVID‐19) pandemic in Italy.MethodsWe used a mathematical, probabilistic modelling approach evaluating three hypothetical ‘Inefficient’, ‘Efficient experimental’ and ‘WHO Target’ screening scenarios differing by treatment rates over time. A Markov chain for liver disease progression evaluated the number of active infections, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and HCV liver‐related deaths up to the years 2030 and 2050.ResultsThe ‘WHO Target’ scenario estimated 3900 patients with DC and 600 with HCC versus 4400 and 600 cases, respectively, similar for both ‘Inefficient’ and ‘Efficient experimental’ screening up to 2030. A sharp (10‐fold) decrease in DC and HCC was estimated by the ‘WHO Target’ scenario compared with the other two scenarios in 2050; the forecasted number of DC was 420 cases versus 4200 and 3800 and of HCC <10 versus 600 and 400 HCC cases by ‘WHO Target,’ ‘Inefficient’ and ‘Efficient experimental’ scenarios, respectively. A significant decrease of the cumulative estimated number of liver‐related deaths was observed up to 2050 by the ‘WHO Target’ scenario (52000) versus ‘Inefficient’ or ‘Efficient experimental’ scenarios (79 000 and 74 000 liver‐related deaths, respectively).ConclusionsOur estimates highlight the need to extensively and efficiently address HCV screening and cure of HCV infection in order to avoid the forecasted long‐term HCV adverse outcomes in Italy.

“…4 Without the implementation of dedicated screening policies, Italy will remain off-track and will reach the HCV elimination goal no earlier than 2037. 5 Despite local programs of HCV screening in high-risk groups [i.e., prisoners and addiction service (AS) attendees], large-scale elimination plans addressing the general population had never been developed, in Italy. Thus, in 2019, the Italian Government allocated 71.5 million Euros to promote regional elimination programs 6 targeting individuals born between 1969 and 1989, in addition to all people from AS and prisons.…”

Section: Introductionmentioning

confidence: 99%

“…Mathematical models endorsed by the Italian National Health System (INHS) estimated that in 2019 nearly 300 000 individuals (vs. 185 000 already treated) were still in need of anti‐HCV treatment in Italy, with most of them being unaware of their infection 4 . Without the implementation of dedicated screening policies, Italy will remain off‐track and will reach the HCV elimination goal no earlier than 2037 5 …”

Section: Introductionmentioning

confidence: 99%

A territory‐wide opportunistic, hospital‐based HCV screening in the general population from northern Italy: The 1969–1989 birth‐cohort

D'Ambrosio,

Piccinelli,

Beccalli

et al. 2023

Background and AimThe World Health Organization (WHO) goal of Hepatitis C Virus (HCV) elimination by 2030 rose awareness about the need of screening plans, worldwide. In Italy, graduated screening starting from people born in 1969–1989 might be the most‐effective strategy. We performed an opportunistic HCV screening study in the general population attending health facilities in Lombardy region, Northern Italy.MethodsThis is a prospective, multicenter, territory‐wide, opportunistic study supported by the Regional Government of Lombardy, Italy. Between June 2022 and December 2022, all subjects born in 1969–1989, hospitalized or accessing blood collection centres were offered anti‐HCV and HCV–RNA tests. Patients with known anti‐HCV positivity and/or previous anti‐HCV treatment were excluded. Demographic features were uploaded into a regional web‐based platform.ResultsIn total, 120 193 individuals were screened in 75 centres. Mean age was 44 (±6) years, 65.2% were females, 83.7% were tested at blood collection centres. Anti‐HCV tested positive in 604 (0.50%) subjects: mean age 47 (±5), 51.1% females. HCV seroprevalence was higher in males (p < 0.00001), elderly (p < 0.00001) and in‐ vs. outpatients (p = 0.0009). HCV–RNA was detectable in 125 out of 441 (28.3%) anti‐HCV positive subjects. Actively infected patients were 46 (±6) years old, mainly males (56.8%). The overall prevalence of active HCV infection was 0.10%, higher in elderly (p = 0.0003) and in in‐patients (p = 0.0007). Among 93 HCV–RNA positive patients, the median age was 48 years, 58% males, 62% Italian born, median HCV–RNA levels were 6,1 log IU/mL, liver stiffness measurement (LSM) values 5.5 (3.1–29.9) kPa and ALT levels 48 U/L.ConclusionsThe prevalence of active HCV infection in the 1969–1989 population attending health facilities in Lombardy was low. Most viremic patients were Italian‐born, with mild liver disease but high‐HCV–RNA levels. Due to the higher prevalence in the elderly, the extension of such opportunistic screening programs to lower birth cohorts would be warranted.