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1.
Liver Int ; 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33590608

RESUMO

Despite universal health coverage in France, migrants face specific socioeconomic barriers that increase the likelihood of a suboptimal cascade of care for chronic hepatitis C virus (HCV) infection and impaired treatment effectiveness in this sub-population. We selected data collected from 2012 to 2018 from the ANRS CO22 HEPATHER prospective cohort study for chronic HCV participants with available data on treatment failure (defined as the presence of a detectable HCV-RNA load 12 weeks after their first DAA treatment ended). We performed multivariable Poisson regression models to test whether treatment failure rates differed significantly between HCV-infected migrants and non-migrants receiving DAA in France (cross-sectional analysis), while taking into account the former's world region of birth and other potential social vulnerability factors. Among the study population's 7,879 patients, 5,829 (74%) were non-migrants and 2,050 (26%) migrants. Median [interquartile range] age was 57 [51-65] years, 4433 (56%) were men and 369 (5%) of the entire study population had treatment failure. After multivariable adjustment, only migrants from Central Asia were at higher risk of treatment failure than non-migrants (aIRR = 2.83; 95% CI [1.72, 4.65]). Results from this large-scale study performed in France suggest a higher risk of DAA treatment failure in migrants from Central Asia than in non-migrants and confirm the overall low treatment failure rate in chronic HCV patients treated with DAA (whether migrants or not). Simplified models of care taking into account language and cultural barriers are needed to improve DAA effectiveness in migrants from Central Asia.

3.
Asian Pac J Cancer Prev ; 21(12): 3453-3459, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369439

RESUMO

OBJECTIVE: Elimination of viral hepatitis by 2030 as one of the international Sustainable Development Goals puts the hepatitis B vaccination on the forefront. However, barriers to vaccination reported in various studies are of concern. This study explores the global barriers for effective uptake of Hepatitis-B vaccination. METHODS: A scoping review of studies reporting hepatitis B vaccination barriers was done using PMC data base and Google scholar search engine. About 803 journal articles and reports on hepatitis B barriers were retrieved but only 36 most relevant items during last 10 years were identified, pile sorted, grouped and analyze. RESULTS: Overall 74 barriers have been identified for effective uptake of hepatitis-B vaccines. Most studies focused on non-zero dose of hepatitis B vaccine, One-third of the barriers are related to system issues, one-fourth of the barriers were related to caregiver education or awareness, fear of side effect, migration etc., one-fifth barriers were related to service provider issues like poor out-reach, home visits, poor communication and/relation with the caregivers, failure to identify unimmunized children etc., and other barriers were social-cultural issues. The review reveals limited availability and accessibility to health-facility based immunization, lack of awareness among caregivers, poor communication by the healthcare workers and negative relationships with the beneficiaries, cost of vaccine in private sector, inconvenience time and place of vaccination etc. as the major barriers for hepatitis B vaccination. Barriers varied from country to country. CONCLUSION: Myriad barriers for reduced hepatitis-B vaccine uptake need to be addressed contextually as countries are at different stages of hepatitis-B vaccination implementation.

4.
Zhonghua Gan Zang Bing Za Zhi ; 28(10): 812-816, 2020 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-33105922

RESUMO

Recently, global hepatitis C testing and treatment have made some progress with the popularization of direct-acting antiviral drugs (DAAs), application of new detection technologies and service models. By 2017, 5 million hepatitis C patients had received DAA treatment, which has surpassed the 2020 treatment target set by the World Health Organization's hepatitis strategy. However, on a global scale, the scope of hepatitis C testing and treatment remains severely inadequate, especially in countries with a high burden of hepatitis C and low-and middle-income countries. In addition, the coverage of harm reduction interventions for injecting drug users is low and the progress is slow. Therefore, achieving the goal of eliminating hepatitis C by 2030 is a huge challenge. Overcoming barriers to prevention and treatment, thereby accelerating progress in eliminating hepatitis C, depends on the strong political will, increasing fund, epidemic and prevention analysis based on the deeper implementation of existing effective measures and rapid use and promotion of new detection and treatment tools. Importantly, Universal Health Coverage (UHC) provides an opportunity to countermeasures the challenges and expands effective prevention and control measures.


Assuntos
Antivirais , Erradicação de Doenças , Hepatite C , Antivirais/uso terapêutico , Saúde Global , Hepacivirus , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Humanos
6.
J Hepatol ; 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32971137

RESUMO

BACKGROUND AND AIMS: More than 292 million people are living with hepatitis B worldwide and are at risk of death from liver cirrhosis and liver cancer. The World Health Organization (WHO) has set global targets for the elimination of viral hepatitis as a public health threat by 2030. However, current levels of global investment in viral hepatitis elimination programmes are insufficient to achieve these goals. METHODS: To catalyse political commitment and to encourage domestic- and international-financing, we used published modelling data and key stakeholder interviews to develop an investment framework to demonstrate the return on investment for viral hepatitis elimination. RESULTS: The framework utilizes a public health approach to identify evidence-based national activities that reduce viral hepatitis-related morbidity and mortality, as well as international activities and critical enablers that allow countries to achieve maximum impact on health outcomes from investment to achieve WHO 2030 elimination targets. CONCLUSION: Focusing on hepatitis B, this health policy paper employs the investment framework to estimate the substantial economic benefits of investing in the elimination of hepatitis B and demonstrates how such investments could be cost-saving by 2030.

7.
Int J Health Plann Manage ; 35(5): 1098-1110, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32663905

RESUMO

Despite the vital role of accurate health information in reducing the spread of Hepatitis B virus (HBV) in endemic contexts such as Ghana, little is known about how health information sources may influence disparities in the knowledge of HBV transmission among women and men. This study examines the association between sources of health information and knowledge of HBV transmission in the Upper West Region (UWR) of Ghana. Data from a cross-sectional survey (n = 1061) was analyzed using gender-specific multivariate ordered logistic regression models. The results show that, women who obtained health information from religious-based programs (OR = 4.04, P < .05), higher-level facilities (OR = 2.37, P < .05), and primary health facilities (OR = 1.83, P < .1) were more likely to have good knowledge of HBV transmission compared to non-facility-based programs. Similarly, men who accessed health information from religious-based programs only, were more likely to have good knowledge of HBV transmission (OR = 2.14, P < .05) compared to non-facility-based programs. The results demonstrate the importance of health information sources on knowledge of disease transmission and prevention in a resource-poor context. Based on our findings, we suggest the scaling-up of information programs at health facilities in rural areas and the expansion of HBV services in the UWR in contribution towards the attainment of SDG #3.3.

8.
BMJ Glob Health ; 5(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32605935

RESUMO

China has the highest number of hepatitis B and C cases globally. Despite remarkable achievements, China faces daunting challenges in achieving international targets for hepatitis elimination. As part of a large-scale project assessing China's progress in achieving health-related Sustainable Development Goals using quantitative, qualitative data and mathematical modelling, this paper summarises the achievements, gaps and challenges, and proposes options for actions for hepatitis B and C control. China has made substantial progress in controlling chronic viral hepatitis. The four most successful strategies have been: (1) hepatitis B virus childhood immunisation; (2) prevention of mother-to-child transmission; (3) full coverage of nucleic acid amplification testing in blood stations and (4) effective financing strategies to support treatment. However, the total number of deaths due to hepatitis B and C is estimated to increase from 434 724 in 2017 to 527 829 in 2030 if there is no implementation of tailored interventions. Many health system barriers, including a fragmented governance system, insufficient funding, inadequate service coverage, unstandardised treatment and flawed information systems, have compromised the effective control of hepatitis B and C in China. We suggest five strategic priority actions to help eliminate hepatitis B and C in China: (1) restructure the viral hepatitis control governance system; (2) optimise health resource allocation and improve funding efficiency; (3) improve access to and the quality of the health benefits package, especially for high-risk groups; (4) strengthen information systems to obtain high-quality hepatitis epidemiological data; (5) increase investment in viral hepatitis research and development.

9.
Int J Health Policy Manag ; 9(6): 229-232, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32613790

RESUMO

Chronic hepatitis C virus (HCV) infection, associated with severe liver disease and cancer, affects 70 million people worldwide. New treatments with direct-acting-antivirals offer cure for about 95% of affected individuals; however, treatment costs may be prohibitive in both the poorest and richest nations. Opting for cure may require sacrificing essential household assets. We highlight the financial dilemmas involved, drawing parallels between Ethiopia and the United States, countries where universal health coverage does not yet exist. The World Health Organization (WHO) declaration for HCV eradication by 2030 will only become reality if universal access to efficacious and affordable treatment is guaranteed for everyone.

11.
Gastroenterol Clin North Am ; 49(2): 253-277, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32389362

RESUMO

The World Health Organization has called for the elimination of hepatitis C virus (HCV) as a public health threat by 2030. Highly effective direct-acting antiviral agents provide the therapeutic tools required for elimination. In the absence of a vaccine, HCV elimination will require enhanced primary prevention and an increase in the proportions of people diagnosed and treated. Given that globally only 20% of people with chronic HCV are diagnosed, and around 5% have initiated HCV treatment, the task ahead is enormous. But, global public health needs optimism, and countries currently on track for HCV elimination provide a pathway forward.


Assuntos
Antivirais/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/prevenção & controle , Anilidas/administração & dosagem , Antivirais/economia , Benzofuranos/administração & dosagem , Carbamatos/administração & dosagem , Quimioterapia Combinada , Saúde Global , Custos de Cuidados de Saúde , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Humanos , Imidazóis/administração & dosagem , Sofosbuvir/administração & dosagem , Sulfonamidas/administração & dosagem , Uracila/administração & dosagem , Uracila/análogos & derivados , Organização Mundial da Saúde
12.
Brasília, D.F.; OPAS; 2020-05-19. (OPAS/BRA/FPL/IM/COVID-19/20-0010).
em Português | PAHO-IRIS | ID: phr2-52248

RESUMO

Objetivo: • Orientar sobre a vacinação de recém-nascidos com as vacinas BCG e hepatite B e no contexto da pandemia da doença causada pelo novo coronavírus (COVID-19), com o intuito de manter uma alta cobertura vacinal. Principais considerações: • A pandemia de COVID-19 está tendo um considerável impacto econômico, social e de saúde na população, e colocando pressão sobre os serviços de saúde. Com base nas informações disponíveis até o momento, idosos e pessoas de qualquer idade com doenças preexistentes têm maior risco de evoluir para um quadro grave de COVID-19. • Foram notificados apenas alguns poucos casos de COVID-19 em recém-nascidos. Atualmente, não há evidências de transmissão vertical do SARS-CoV-2 de gestantes infectadas para os fetos (1,2), e o vírus não foi encontrado em amostras de leite materno. No entanto, estudos de rastreamento com gestantes que deram à luz em dois hospitais, durante o pico da epidemia na cidade de Nova York (Estados Unidos), mostraram que entre 15%-20% estavam infectadas com COVID-19, embora mais de dois terços dessas gestantes infectadas não apresentassem nenhum sintoma. Para evitar que as mulheres transmitam a COVID-19 para os recém-nascidos no período pós-parto, é necessário implementar medidas preventivas, como o uso de máscara durante a amamentação...


Assuntos
Infecções por Coronavirus , Coronavirus , Imunização , Vacinação , Vacina BCG , Hepatite B , Criança , Recém-Nascido
13.
Washington, D.C.; OPS; 2020-05-19. (OPS/FPL/IM/COVID-19/20-0010).
em Espanhol | PAHO-IRIS | ID: phr-52227

RESUMO

El documento brinda orientaciones respecto a la vacunación de los recién nacidos con la vacuna de la hepatitis B y la BCG en el contexto de la pandemia de COVID-19, con el fin de mantener altas coberturas de vacunación.


Assuntos
Infecções por Coronavirus , Coronavirus , Vacinas , Vacina BCG , Pandemias , Imunização
14.
Washington, D.C.; PAHO; 2020-05-19. (PAHO/FPL/IM/COVID-19/20-0010).
em Inglês | PAHO-IRIS | ID: phr-52226

RESUMO

These preliminary recommendations provide guidance regarding vaccination of newborns with hepatitis B and BCG vaccines in the context of the COVID-19 pandemic, in order to maintain high vaccination coverage.


Assuntos
Infecções por Coronavirus , Coronavirus , Recém-Nascido , Pandemias , Hepatite B , Vacina BCG , Imunização
15.
Buenos Aires; OPS; 2020-03-02. (OPS/ARG/20-0001).
em Espanhol | PAHO-IRIS | ID: phr2-51904

RESUMO

[Introducción]. Durante el año, el país obtuvo importantes logros en los avances hacia la Salud Universal, basada en una estrategia de atención primaria. Son significativos los pasos dados para fortalecer capacidades en el primer nivel de atención para personas mayores, así como para personas afectados por hipertensión, el uso problemático de sustancias psicoactivas y trastornos mentales. Hubo un impulso importante en la iniciativa para eliminar la transmisión de madre a hijo de VIH, sífilis, Chagas y hepatitis B, y avances transformativos y modernizados en el sistema de información sanitaria para poder medir el acceso a los servicios de salud y su calidad. La certificación de la eliminación de la malaria otorgada por la OMS constituye un hito para Argentina en salud pública. Asimismo, la evaluación externa al país en la aplicación del Reglamento Sanitario Internacional significa un avance importante y un ejemplo para otros países de la región. El Diagnóstico de la Situación sobre Clima y Salud en la Argentina y el desarrollo de un capítulo de salud en el Plan Nacional de Adaptación al Cambio Climático representan otros logros para manejar riesgos alineados con estándares internacionales. Además, Argentina cooperó con el Caribe para fortalecer capacidades en la lucha contra la resistencia antimicrobiana. Los progresos también son significativos en el análisis sobre el gasto de Argentina en salud y en agua y saneamiento, utilizando instrumentos internacionales que ayudan a transparentar estos desembolsos y mejorar en eficiencia e impacto. Otro logro inédito fue el desarrollo y consenso alcanzado para una Agenda Nacional de Investigación en Salud, así como la promoción en el ámbito legislativo del sistema de advertencias sanitarias en el frente de los envases de productos alimenticios para la prevención de la obesidad, una epidemia que afecta de manera alarmante al país


Assuntos
Doenças Negligenciadas , Malária , Doença de Chagas , Resistência a Inseticidas , Transmissão Vertical de Doença Infecciosa , Tuberculose , Rotulagem de Alimentos , Mudança Climática , Água Potável , Violência de Gênero , Vigilância em Saúde do Trabalhador , Masculinidade , Gastos em Saúde , Gestão do Conhecimento para a Pesquisa em Saúde , Regulamento Sanitário Internacional , Argentina
16.
Artigo em Inglês | PAHO-IRIS | ID: phr-51901

RESUMO

To the editor: In the United States (US), an estimated 2.4 million persons have chronic infection with hepatitis C virus (HCV). The number of deaths from HCV-related mortality is greater than that of HIV and tuberculosis combined. Treatment with direct-acting antivirals (DAAs), usually 1-3 pills a day for 8 or 12 weeks, can cure over 95% of patients. Successful treatment of HCV has been shown to greatly reduce liver-related as well as all-cause mortality. American Indian and Alaska Native (AI/AN) people have over twice the national rate of HCV-related mortality. The largest health care provider for AI/AN communities is the Indian Health System, a national network of federal (Indian Health Service), tribal, and urban health facilities, comprised mostly of rural primary care clinics. As part of the Indian Health System response to HCV, health facilities have access to tele-mentoring support such as the ECHO (Extension for Community Healthcare Outcomes) model, which has demonstrated excellent outcomes in treating HCV. The program connects rural clinicians (‘spokes’) to a specialist team (‘hub’). These participants meet regularly via low-bandwidth video conference technology. The format of case-based learning, supported by short didactic presentations, aims to scale up clinical capacity across a health network. Patient presentations entail a brief de-identified standardized form with a patient’s clinical history to assess liver disease severity and determine optimal HCV treatment. [...]


Assuntos
Hepatite C , Mortalidade , Doenças Transmissíveis , Nativos do Alasca , Índios Norte-Americanos , Saúde da População Urbana , Serviços Urbanos de Saúde , Hepatite , Telemedicina , Telemedicina para as Zonas Rurais e Remotas , Serviços de Saúde do Indígena , Saúde de Populações Indígenas , Organizações Indígenas
17.
Artigo em Português | PAHO-IRIS | ID: phr-51858

RESUMO

[RESUMO]. Objetivo. Apresentar um método para identificar áreas críticas relativas a doenças infecciosas e parasitárias selecionadas para fins de vigilância em saúde, analisando a sua associação a indicadores de pobreza no Brasil. Métodos. Foram mapeadas as taxas de incidência de dengue, doença de Chagas aguda, esquistossomose, hanseníase, hepatite A, leishmaniose tegumentar, leishmaniose visceral, leptospirose, malária e tuberculose. Foram realizadas análises para os anos de 2010 a 2017 a partir de um indicador síntese, calculado como a média dos coeficientes médios de incidência para cada agravo normalizada pela média e desvio padrão durante o período analisado. A estimativa da base populacional foi de 2014. Os coeficientes calculados foram estratificados para classificação dos municípios em criticidade muito alta, alta, média, baixa ou muito baixa conforme cada doença. Também foram selecionados indicadores de diferentes dimensões que expressassem desigualdades socioeconômicas e segregação espacial nos municípios brasileiros, sendo testada a sua associação às doenças em estudo. Resultados. O indicador mostrou que 40,5% dos municípios brasileiros apresentam alta criticidade, sobretudo nas regiões Norte, parte do Nordeste e Centro-Oeste. Os indicadores “proporção de pobreza”, “lixo no entorno”, “esgoto no entorno” e “famílias chefiadas por mulheres” podem aumentar a chance de a localidade apresentar maior criticidade para as doenças. O indicador “esgoto adequado” pode ser considerado potencial fator de proteção. Conclusões. A técnica utilizada foi adequada para orientar ações de vigilância no país e permite a articulação entre vigilâncias locais e demais setores para contornar os problemas de saúde causados por doenças infecciosas e parasitárias e fatores relacionados.


[ABSTRACT]. Objective. To present a method to identify critical areas for selected infectious and parasitic diseases for the purpose of health surveillance and to analyze the association between these critical areas and poverty indicators in Brazil. Method. The following incidence rates were mapped: dengue, acute Chagas disease, schistosomiasis, Hansen’s disease, hepatitis A, cutaneous leishmaniasis, visceral leishmaniasis, leptospirosis, malaria, and tuberculosis. The analyses were performed for the period from 2010 to 2017 based on a synthetic indicator calculated as the mean of mean incidence coefficients for each disorder, normalized by the mean and standard deviation during the period of analysis. A 2014 population estimate was used. The calculated coefficients were stratified for classification of municipalities into very high, high, medium, low, or very low criticality according to each disorder. Indicators expressing several socioeconomic dimensions and space segregation in Brazilian municipalities were also selected and tested regarding their association with the transmission of the diseases under study. Results. The indicator showed that 40.5% of Brazilian municipalities had high criticality for the diseases of interest, especially in the North, parts of the Northeast, and Midwest. Indicators “proportion of poverty,” “garbage in surroundings,” and “families headed by women” increased the chance of higher criticality for the diseases. The indicator “adequate sewer system” was a potential protection factor. Conclusions. The technique used was adequate to guide surveillance actions in the country and allows articulation between local surveillance efforts and other sectors to resolve health problems caused by infectious and parasitic diseases and associated factors.


[RESUMEN]. Objetivo. Presentar un método para identificar áreas críticas relacionadas con ciertas enfermedades infecciosas y parasitarias con fines de vigilancia sanitaria y analizar su asociación con los indicadores de pobreza en Brasil. Métodos. Se cartografiaron las tasas de incidencia de dengue, enfermedad de Chagas aguda, esquistosomiasis, lepra, hepatitis A, leishmaniasis cutánea, leishmaniasis visceral, leptospirosis, malaria y tuberculosis. Se efectuaron análisis para los años 2010 a 2017 a partir de un indicador de síntesis, calculado como el promedio de los coeficientes de incidencia promedio para cada enfermedad, normalizado por la media y la desviación estándar durante el período analizado. La base de población estimada fue la de 2014. Los coeficientes calculados se estratificaron para clasificar los municipios según presentaran una situación crítica muy alta, alta, media, baja o muy baja para cada enfermedad. Se seleccionaron también indicadores de diferentes dimensiones que expresaran las desigualdades socioeconómicas y la segregación espacial en los municipios brasileños, y se evaluó su asociación con las enfermedades estudiadas. Resultados. El indicador demostró que el 40,5% de los municipios brasileños presentan una situación crítica alta, en especial en las regiones Norte y Centro-oeste y parte del Nordeste. Los indicadores "proporción de pobreza", "basura en los alrededores", "aguas servidas en los alrededores" y "familias encabezadas por mujeres" pueden aumentar la posibilidad de que la localidad presente una situación más crítica para las enfermedades. El indicador "red cloacal adecuada" puede considerarse un potencial factor de protección. Conclusiones. La técnica utilizada fue adecuada para orientar las acciones de vigilancia sanitaria en el país y permite la articulación entre la vigilancia local y otros sectores para evitar los problemas de salud causados por las enfermedades infecciosas y parasitarias y los factores relacionados.


Assuntos
Doenças Transmissíveis , Fatores Socioeconômicos , Análise Espacial , Brasil , Doenças Transmissíveis , Fatores Socioeconômicos , Análise Espacial , Brasil , Doenças Transmissíveis , Fatores Socioeconômicos , Análise Espacial
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