BACKGROUND: There are limited data on end-stage liver disease (ESLD) and mortality in people with HIV (PWH) coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). METHODS: All PWH aged greater than 18 under follow-up in EuroSIDA positive for HBsAg (HBV), and/or HCVRNA+, were followed from baseline (latest of 1 January 2001, EuroSIDA recruitment, known HBV/HCV status) to ESLD, death, last visit, or 31 December 2020. Follow-up while HCVRNA- was excluded. In two separate models, Poisson regression compared three groups updated over time; HIV/HBV, HIV/HCV, and HIV/HBV/HCV. RESULTS: Among 5733 included individuals, 4476 (78.1%) had HIV/HCV, 953 (16.6%) had HIV/HBV and 304 (5.3%) had HIV/HBV/HCV. In total, 289 (5%) developed ESLD during 34 178 person-years of follow-up (PYFU), incidence 8.5/1000 PYFU [95% confidence interval (CI) 7.5-9.4] and 707 deaths occurred during 34671 PYFU (incidence 20.4/1000 PYFU; 95% CI 18.9-21.9). After adjustment, compared with those with HIV/HCV, persons with HIV/HBV had significantly lower rates of ESLD [adjusted incidence rate ratio (aIRR) 0.53; 95% CI 0.34-0.81]. Those with HIV/HBV/HCV had marginally significantly higher rates of ESLD (aIRR 1.49; 95% CI 0.98-2.26). Those under follow-up in 2014 or later had significantly lower rates of ESLD compared with 2007-2013 (aIRR 0.65; 95% CI 0.47-0.89). Differences in ESLD between the three groups were most pronounced in those aged at least 40. After adjustment, there were no significant differences in all-cause mortality across the three groups. CONCLUSION: HIV/HBV-coinfected individuals had lower rates of ESLD and HIV/HBV/HCV had higher rates of ESLD compared with those with HIV/HCV, especially in those aged more than 40. ESLD decreased over time across all groups. CLINICALTRIALSGOV IDENTIFIER: NCT02699736.
- MeSH
- Hepacivirus MeSH
- HIV infekce * komplikace MeSH
- konečné stadium selhání jater * MeSH
- lidé MeSH
- RNA MeSH
- virus hepatitidy B MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Following the introduction of direct-acting antiviral therapy in 2013, WHO launched the first Global Health Sector Strategy on Viral Hepatitis. We describe a hepatitis C virus (HCV) cascade of care in people with HIV (PWH) across Europe in terms of reaching the WHO elimination targets of diagnosing 90% and treating 80% of HCV-infected individuals. METHODS: HIV/HCV-coinfected participants in the EuroSIDA cohort under prospective follow-up at October 1, 2019, were described using a nine-stage cascade of care. Care cascades were constructed across Europe, on a regional (n = 5) and country (n = 21) level. RESULTS: Of 4773 anti-HCV positive PWH, 4446 [93.1%, 95% confidence interval (CI) 92.4-93.9)] were ever tested for HCV RNA, and 19.0% (95% CI 16.4-21.6) were currently HCV RNA positive, with the highest prevalence in Eastern and Central-Eastern Europe (33.7 and 29.6%, respectively). In Eastern Europe, 78.1% of the estimated number of chronic infections have been diagnosed, whereas this proportion was above 95% in the other four regions. Overall, 3116 persons have ever started treatment (72.5% of the ever chronically infected, 95% CI 70.9-74.0) and 2404 individuals (55.9% of the ever chronically infected, 95% CI 53.9-57.9) were cured. Cure proportion ranged from 11.2% in Belarus to 87.2% in Austria. CONCLUSION: In all regions except Eastern Europe, more than 90% of the study participants have been tested for HCV-RNA. In Southern and Central-Western regions, more than 80% ever chronically HCV-infected PWH received treatment. The proportion with cured HCV infection did not exceed 80% in any region, with significant heterogeneity between countries. SUMMARY: In a pan-European cohort of PWH, all regions except Eastern Europe achieved the WHO target of diagnosing 90% of chronic HCV infections, while the target of treating 80% of eligible persons was achieved in none of the five regions.
- MeSH
- antivirové látky terapeutické užití MeSH
- chronická hepatitida C * komplikace farmakoterapie epidemiologie MeSH
- Hepacivirus genetika MeSH
- hepatitida C * komplikace farmakoterapie epidemiologie MeSH
- HIV infekce * komplikace farmakoterapie epidemiologie MeSH
- koinfekce * farmakoterapie MeSH
- lidé MeSH
- prospektivní studie MeSH
- RNA terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
All-oral direct-acting antiviral drugs (DAAs) for hepatitis C virus, which have response rates of 95% or more, represent a major clinical advance. However, the high list price of DAAs has led many governments to restrict their reimbursement. We reviewed the availability of, and national criteria for, interferon-free DAA reimbursement among countries in the European Union and European Economic Area, and Switzerland. Reimbursement documentation was reviewed between Nov 18, 2016, and Aug 1, 2017. Primary outcomes were fibrosis stage, drug or alcohol use, prescriber type, and HIV co-infection restrictions. Among the 35 European countries and jurisdictions included, the most commonly reimbursed DAA was ombitasvir, paritaprevir, and ritonavir, with dasabuvir, and with or without ribavirin (33 [94%] countries and jurisdictions). 16 (46%) countries and jurisdictions required patients to have fibrosis at stage F2 or higher, 29 (83%) had no listed restrictions based on drug or alcohol use, 33 (94%) required a specialist prescriber, and 34 (97%) had no additional restrictions for people co-infected with HIV and hepatitis C virus. These findings have implications for meeting WHO targets, with evidence of some countries not following the 2016 hepatitis C virus treatment guidelines by the European Association for the Study of Liver.
- MeSH
- antivirové látky ekonomika terapeutické užití MeSH
- chronická hepatitida C komplikace farmakoterapie ekonomika MeSH
- Evropská unie MeSH
- HIV infekce komplikace MeSH
- koinfekce MeSH
- lidé MeSH
- náklady na léky * MeSH
- úhrada zdravotního pojištění * MeSH
- zdravotní politika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Švýcarsko MeSH
BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.
- MeSH
- alokace zdrojů MeSH
- celosvětové zdraví * MeSH
- lidé MeSH
- poskytování zdravotní péče MeSH
- rozvojové země MeSH
- výzkum zdravotnických služeb * MeSH
- zdravotní politika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Objective: To assess the attitudes of Lithuanian residents towards the protection of confidentiality in the sexual and reproductive health care of adolescents. Material and Methods: A public opinion survey was performed in August 2005. A random sample, taking into account age, sex, education, employment, family status, place of residence of 1,054 Lithuanian residents aged 16–74 was interviewed in their households. The topics dealt with in the 23-item questionnaire concerned attitudes towards confidentiality in adolescents' sexual and reproductive health care as well as towards sexual and reproductive health promotion for them. Results: More than half (58%) of the respondents believed that confidentiality is an important issue in case of sexual and reproductive health services that address adolescents. Although only 12% of Lithuanians were ready to agree with the legalization of the right to confidentiality in health care for those younger than 16, at least one-third of the respondents stated that physicians have to protect confidential counselling for 14–15-year-old adolescents on inter alia contraception, pregnancy and sexually transmitted infections. Forty-two percent of the respondents gave top priority to the legal initiative focused on improvement of confidentiality protection. Other promising strategies selected by Lithuanian residents included the development of policies concerning confidentiality protection for minor patients, assuring the privacy of consultations and protecting the medical record keeping system. Conclusions: The Lithuanian residents surveyed had a positive attitude towards confidential sexual and reproductive health care for adolescents. They stated that guarantees of confidentiality should depend on the reason for the consultation and the age of the patient. The most promising initiatives for the improved protection of confidentiality include strengthening legislation and improving organizational procedures in health care settings.
- MeSH
- dospělí MeSH
- důvěrnost informací MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- postoj MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- služby v oblasti reprodukčního zdraví MeSH
- zdravotnické služby pro mladistvé etika MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Litva MeSH
Background: In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing these infections. However, structural barriers can limit their effectiveness by hindering access. Methods: Through use of a semi-structured online survey sent to 65 professionals in the region, this study explores the prevalences of age restrictions, user fees or a lack of confidentiality for these programmes as well as HIV/HCV testing programmes. Results: Twenty respondents reported that age restrictions were not widespread in the 11 reporting countries, apart from for OST. User fees were found to be very common in HCV testing and varied for other services. It was stated to be common to inform parents of young IDUs who receive HIV services, but not to inform public authorities when IDUs enter harm reduction programmes. Conclusion: Where access to services is limited or confidentiality is compromised, as reported in this pilot study, it is crucial that health-care guidelines and national legislation are reformed to ensure access to these evidence-based interventions.
- MeSH
- hepatitida C diagnóza prevence a kontrola přenos MeSH
- HIV infekce diagnóza prevence a kontrola přenos MeSH
- internet využití MeSH
- intravenózní abúzus drog epidemiologie komplikace prevence a kontrola MeSH
- lidé MeSH
- methadon terapeutické užití MeSH
- pilotní projekty MeSH
- poruchy spojené s užíváním psychoaktivních látek komplikace prevence a kontrola MeSH
- preventivní lékařství metody MeSH
- programy výměny jehel a stříkaček metody využití MeSH
- průzkumy a dotazníky využití MeSH
- společné užívání jehel statistika a číselné údaje škodlivé účinky MeSH
- zdravotní politika trendy zákonodárství a právo MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- střední Asie MeSH
- východní Evropa MeSH
First published xxvi, 162 stran ; 23 cm
The publication focuses on the providing of health care to HIV-positive people and on related cultural aspects. Intended for the professional public.
- MeSH
- AIDS MeSH
- HIV MeSH
- náboženství a lékařství MeSH
- péče o pacienta MeSH
- poskytování zdravotní péče MeSH
- postoj MeSH
- Publikační typ
- sborníky MeSH
- Konspekt
- Veřejné zdraví a hygiena
- NLK Obory
- veřejné zdravotnictví
When the HIV epidemic officially hit western Europe in the early 1980s, central and eastern Europe were almost completely spared due to the isolation of the Soviet Union. However, in the mid-1990s, reported new cases of HIV in eastern European countries began to increase exponentially. While there have been many declarations and strategies addressing HIV/AIDS, today the goal is universal access to HIV/AIDS prevention, treatment, care and support services by 2010. The articles included in this thematic issue of the Central European Journal of Public Health on HIV/AIDS reflect this, while the ten priorities listed below are immediate and sometimes innovative research needs in the context of preventing HIV among the most-at-risk populations. While by no means exhaustive, they are intended to point out gaps in existing knowledge and thus serve as inspiration for future research efforts.
- MeSH
- cíle MeSH
- dlouhodobě přežívající nosiči HIV MeSH
- dostupnost zdravotnických služeb MeSH
- HIV infekce farmakoterapie prevence a kontrola MeSH
- komorbidita MeSH
- lidé MeSH
- práva pacientů MeSH
- rozšiřování inovací MeSH
- výzkum MeSH
- zdravotní politika MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Geografické názvy
- Evropa MeSH
