HBV and HCV testing outcomes among marginalized communities in Italy, 2019–2024: a prospective study

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Europe Pub Date : 2025-02-01 DOI:10.1016/j.lanepe.2024.101172

Monica Monti , Teresita Caruso , Alice Castellaccio , Irene De Giorgi , Gabriella Cavallini , Maria Laura Manca , Serena Lorini , Silvia Marri , Luisa Petraccia , Francesco Madia , Cristina Stasi , Laura Carraresi , Elisabetta Lorefice , Sara Irene Bonelli , Alessandro Nerli , Mouheb M.A. Mudalal , Lorenzo Martini , Stefano Gitto , Eleonora Carradori , Adela Xheka , Laura Gragnani

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Abstract

Background

The health of the marginalized populations is crucial for public health and inequalities. The World Health Organization (WHO) Global Hepatitis Report 2024 stated that over 304 million people were living with Hepatitis B Virus (HBV)/Hepatitis C Virus (HCV) infection in 2022. We performed HBV/HCV screenings among marginalized communities to reveal hidden infections and link-to-care positive participants.

Methods

From January 2019 to May 2024, finger-prick tests were used to conduct on-site screenings at non-profit organizations in Tuscany, Italy. Positive participants were referred to the closest outpatient clinic.

Findings

Eighty/1812 (4.4%) participants were Hepatitis B surface Antigen (HBsAg)+, mostly men (p < 0.001) and non-Italian natives compared to those HBsAg- (p < 0.001). Fifty-two/1812 (2.9%) were anti-HCV+ with a higher proportion of Italians (p < 0.001) and lower education level (p < 0.01) compared to the anti-HCV-. Intravenous drug use was an independent factor for being anti-HCV+ (p < 0.0001). Among the HBsAg + individuals, 66.3% (53/80) were linked and 90.4% (48/53) retained in care (treated/monitored). Of the anti-HCV participants requiring clinical evaluation, 37.8% (14/37) were linked to care, and all the 11/14 (88.6%) viremic patients were successfully treated.

Interpretation

We found higher HBV/HCV positivity compared to national prevalences. Participation and linkage to care were successful. The young mean age (33.6 yrs) of HBsAg + individuals, primarily from regions with low vaccinal adherence, indicated geographical origin as a key risk factor. HCV positivity was associated with extreme marginality. The results stress the need to implement marginalized groups screening to target HBV/HCV hidden infections, reducing disparities in healthcare and advancing towards the WHO 2030 elimination goal.

Funding

Gilead Sciences; Fondazione Cassa di Risparmio di Pistoia e Pescia; Regione Toscana.

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2019-2024年意大利边缘化社区HBV和HCV检测结果：一项前瞻性研究

背景：边缘化人群的健康对公共卫生和不平等至关重要。世界卫生组织（世卫组织）《2024年全球肝炎报告》指出，2022年有超过3.04亿人感染乙型肝炎病毒(HBV)/丙型肝炎病毒（HCV）。我们在边缘化社区中进行了HBV/HCV筛查，以发现隐藏的感染和与护理相关的阳性参与者。方法：2019年1月至2024年5月，在意大利托斯卡纳的非营利组织采用手指点刺试验进行现场筛查。阳性参与者被转介到最近的门诊诊所。结果：80 /1812（4.4%）参与者为乙型肝炎表面抗原(HBsAg)+，主要是男性（p 0.001）和非意大利本地人，与HBsAg- (p 0.001)相比。52 /1812例（2.9%）为抗- hcv +，其中意大利人比例较高（p 0.001），教育程度较低（p 0.0001）。在HBsAg +的个体中，66.3%（53/80）与之相关，90.4%（48/53）继续接受护理（治疗/监测）。在需要临床评估的抗hcv参与者中，37.8%（14/37）与护理相关，所有11/14（88.6%）病毒血症患者均获得成功治疗。解释：与全国流行率相比，我们发现HBV/HCV阳性率较高。参与和与护理的联系是成功的。主要来自低疫苗依从性地区的HBsAg +个体的年轻平均年龄（33.6岁）表明地理来源是一个关键的危险因素。HCV阳性与极端边缘化相关。结果强调需要实施边缘化群体筛查，以针对HBV/HCV隐性感染，缩小卫生保健方面的差距，并朝着世卫组织2030年消除目标迈进。资助：Gilead Sciences；Pistoia和pesia的casa和Risparmio基金会；Regione托斯卡尼。

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.