New community strategies for health promotion and screening for the microelimination of hepatitis C in migrants

The validation has focused on the Pakistani migrant population in Barcelona and its metropolitan area, and will now be extended to migrants from other endemic countries and to screening, also, for hepatitis B.

17/09/2020

According to data from the World Health Organization (WHO), there are 71 million people in the world with chronic infection by hepatitis C virus (HCV). New antiviral treatments can cure more than 95% of cases of HCV infection, and WHO has set the goal of eliminating the disease as a public health problem by 2030. But, for many groups, knowledge about the disease and access to diagnosis and treatment are limited. Therefore, micro-elimination strategies are key, such as the one led by Dr. Elisa Martró’s team from Germans Trias i Pujol Hospital and Research Institute (IGTP), with the collaboration of Dr. Jordi Gómez Prat’s team, from the Public and Community Health team at the Preventive Medicine Service of Vall d’Hebron Hospital, focusing on reaching out to the population groups that are known as vulnerable.

The project, called HepC-link, is a prospective study with sampling based on actions carried out in the community. It has acted on 520 migrant people from Pakistan in Barcelona and its metropolitan area. The population from Pakistan is the fifth most common in Catalonia and is one of the countries in which hepatitis C is endemic; recruitment took place between March 2019 and February 2020. The results were presented at the Digital International Liver Congress (ILC2020).

HepC-link combines two strategies, previously validated by the same researchers, to favor access to hepatitis C treatment. On the one hand, the team of Dr. Elisa Martró at IGTP, has been working since 2015 to simplify the diagnosis of hepatitis C by developing and validating a screening strategy in vulnerable populations that combines a rapid antibody tests followed by a laboratory test to detect virus RNA from a few drops of dried blood. This simplified diagnostic strategy has been added to a strategy in the community, for detection, education and health promotion in viral hepatitis, and sensitization towards it diagnosis and treatment developed in Vall d’Hebron and led by Dr. Jordi Gómez i Prat. This is the dynamic educational tool HEPARJOC, which had been proved valid on hepatitis B in migrants from Sub-Saharan Africa, Pakistan and Morocco, mainly. For the HepC-link project, it has been translated into Urdu, the common language in Pakistan, and validated for its effectiveness in increasing knowledge about hepatitis C.

“The game, which is introduced in sessions to the community, ends with the reproduction of a video that encourages testing in order to find out whether they are infected with the hepatitis virus”, explains Dr. Gómez i Prat. “The novelty of HepC-link is that we directly offer the rapid test right there, at the end of the session, with a simple finger prick”, adds Dr. Martró. If the sample is positive for HCV antibodies, a dried blood sample is taken, also from the finger, to check if the person is viremic and, if positive, they are referred directly to do the treatment. “We know that, to reach patients who are not diagnosed, we must go looking for them and with this study we are taking a step closer to them”, says Gómez.

“We have seen that about 35% of the participants did not know what hepatitis C was and 99.4% of participants agreed to take the rapid test after the sessions”, details Martró. “23 (4.6%) of the total of rapid tests were positive for antibodies and 6 of them were viremic (1.2%). The rapid link to treatment allowed us to follow up and treat 5 of these patients”, she adds. Some figures that the researchers consider justify the screening aimed at this group. “It has been a strategy very well accepted by the community and, therefore, its implementation should be considered on a regular basis to community actions”, says Dr. Gómez i Prat. Now the strategy will be applied to migrants from other endemic countries and will be extended to the detection, also, of hepatitis B.

Both research groups have worked in collaboration with professionals from the Center for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT) and the Hepatology Service of Vall d’Hebron University Hospital, with the support of the Agency for Public Health of Catalonia (ASPCAT).


The most affordable treatment

The HepC-link has taken one step forward from being proactive with community education and bringing the diagnosis closer. “Many times, people do not go to the healthcare center for a screening like this, so going closer to them to explain the importance of detection and offer the test makes this project a success”, assesses Tahir Rafi, community agent of health at the Preventive Medicine Service at Vall d’Hebron. In addition, they have brought antiviral treatment closer to those patients who had tested positive for the study. “It is usually a hospital dispensing treatment, we have trained staff at the Drassanes-Vall d’Hebron International Health Unit to facilitate access to treatment for migrants and their follow-up until recovery”, concludes Dr. Maria Buti, who has also collaborated in the project from the Hepatology Service at Vall d’Hebron.

In addition, Dr. Martró has worked with CEEISCAT researchers to compare the data from this community strategy with Pakistani people who went to primary care, accompanied by a cost study. This information will be assessed by the entire team, together with ASPCAT, for its future implementation within the Plan for the Prevention and Control of Hepatitis C in Catalonia.

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