World Hepatitis Day 2021: Vulnerable Populations Cannot Wait- Decentralising Hepatitis B and C Care

[This text has been written by Camila Picchio, Andrea Herranz, and Jeffrey V Lazarus]

This World Hepatitis Day, ISGlobal is celebrating the launch of two projects dedicated to working towards the viral hepatitis elimination targets set out by the World Health Organisation (WHO).

The elimination of the hepatitis B virus (HBV) and the hepatitis C virus (HCV) requires simplifying current models of care and adapting them to specific populations. In particular, it is important to focus on vulnerable populations, who often have difficulty accessing traditional healthcare services and are at high risk for viral hepatitis, such as migrants and people who use drugs.

COVID-19 has disrupted some of the strategies and programmes that were working towards the elimination of viral hepatitis. Nevertheless, in the midst of the pandemic, ISGlobal has launched two new projects aiming to increase screening and access to treatment for these populations.

COVID-19 has disrupted some of the programmes that were working towards the elimination of viral hepatitis. Nevertheless, ISGlobal has launched two new projects aiming to increase screening and access to treatment for vulnerable populations

HBV-COMSAVA

The HBV-COMSAVA project focuses on hepatitis B screening in African migrants living in the Barcelona metropolitan area, who are disproportionately affected by HBV infection compared to the Spanish-born population. In November 2020, the project kicked off by offering decentralised HBV screening in Ghanaian and Senegalese community and religious centres. The aim is to test migrants and link them to care, which can be vaccination for non-immune patients or referral to specialists at Hospital Clínic or Hospital Vall d’Hebron for positive cases.

Photo: Paula Peco Fernández. Study coordinator (Camila Picchio) and a patient. Behind the sign, the team conducting epidemiological surveys with study participants.

Patients are screened with a rapid test that uses a blood sample to detect the presence of the hepatitis B surface antigen (HBsAg). A blood sample is also collected in the community using a plasma separation card (PSC) made by Roche Diagnostics, which is subsequently analysed at the Hepatology Unit of the Vall d’Hebron Research Institute to ascertain viral load, previous resolved infection, and antibodies against the hepatitis delta virus (HDV). The team then returns to the community centres to deliver the results and follow up if necessary. During the course of these interventions, the ISGlobal team can also expedite CatSalut health cards for anyone who does not have one and requires medical services in collaboration with the Department of Health.

Photo: Jan Pilarcik. Blood samples are taken at the community centre so that participants do not have to travel to a health centre. The samples are collected on plasma separation cards and then analyzed at the laboratory.

So far, over 300 people have been screened with a prevalence of about 10%, over 100 have been offered the first dose of the vaccine, and over 30 have been referred to specialists. By the end of 2021, the team hopes to screen a total of 500 people and link them to health care.

Hepatitis C Free Baleares

The second project launched during the pandemic is Hepatitis C Free Baleares, which aims to eliminate hepatitis C among people who use drugs on the Balearic Islands (Mallorca, Menorca, and Ibiza). The project aims to improve HCV testing and linkage to care in people who seek assistance at low-threshold services, including addiction service centres, a non-profit organisation Projecte Home, a mobile methadone unit, and individuals in the prison system. These individuals are screened using a saliva-based rapid detection test to look for the presence of HCV antibodies.

Photo: Andrea Herranz. Health staff from Projecte Home (Mallorca) explaining the project to a participant.

In patients with a positive test result, viremia is confirmed by a routine blood test or by a dried blood spot (DBS) test, which is performed on the spot with a finger-prick blood sample. The samples are sent to the microbiology laboratories of Son Llàtzer Hospital and Son Espases Hospital for analysis. In cases with a positive result, treatment is prescribed via telemedicine by hepatologists from public hospitals on the Balearic Islands. The project also allows treatment initiation, confirmation of being cured, and monitoring for reinfection to be transferred from hospitals to the centres where patients are located.

Photo: Andrea Herranz. Finger-prick blood samples are collected for a dried blood spot test to ascertain the hepatitis C viral load.

Since late March 2021, the project has screened a total of 200 people, 13.5% of whom had an active HCV infection. Approximately 63% of those diagnosed with HCV have started treatment and the rest are in the process of doing so.

Both projects show that by decentralising viral hepatitis care and creating new care pathways, including telemedicine, services will be more patient-centered and better able to reach vulnerable, high-risk populations.

More information

• Lazarus JV, Safreed-Harmon K, Thursz MR et al. The micro-elimination approach to eliminating hepatitis C: strategic and operational considerations. Sem Liv Dis 2018;38(03):181-192.
• Lazarus JV, Pericàs JM, Picchio CA et al. We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade. J Inter Med 2019.
• Lazarus JV, Picchio CA, Guy D et al. Hepatitis C standards of care: a review of good practices since the advent of direct-acting antiviral therapy. Clin Res Hepatol Gastroenterol 2021;45(2):101564.