Eradicating Hepatitis C is the goal that the World Health Organization (WHO) has set by 2030. Today, new generation drugs allow the virus to be treated effectively, but before curing the disease it is essential to strengthen the screening activities to intercept those people who, perhaps without knowing it, have contracted the infection in the course of their lives and today, even without symptoms, risk being a vehicle for contagion.
Numerous projects are underway in Brescia, as the doctor tells us Paola Nasta, infectious disease doctor which collaborates with the FdS association – Il filo della Salute ETS, a non-profit third sector body which through research aims to help people prevent and treat diseases in order to live better and longer.
Why are hepatitis C undeclared projects important?
Hepatitis C is an inflammatory disease of the liver caused by the hepatitis C virus (HCV), which is one of the leading causes of transplantation and the development of chronic liver disease worldwide. such as, for example, chronic hepatitis, liver cirrhosis and liver cancer or hepatocellular carcinoma. Approximately 100 million people worldwide have persistent (chronic) HCV infection, and approximately 400,000 die each year from its consequences. The symptoms can appear several years after the infection and there is therefore a portion of the population that does not know that it is ill and is unaware that it is in turn a vehicle of transmission.
Who is the population most at risk?
Hepatitis C is contracted by contact with infected blood and the population most affected is that aged 50 and over, who became infected in the past years before the HCV virus was discovered and all virtuous behaviors were adopted in Italy which slowed its spread. In the past, the contagion occurred through micro-contamination of blood, for example, through glass syringes that were boiled and reused for more people and more children for home injections of medicines. Dental offices were also a place of contagion: when there was no knowledge of the virus, its transmission routes and there was no attention to sterilization that exists today. Even transfusions in the hospital could transmit the virus.
The Brescia area is an area that in the past has been particularly affected by the HCV virus: what are the incidence data?
In the province of Brescia there was a high rate of HCV infections in people born before 1950, it is believed that the percentage is almost 3% in some areas of the upper Lake Garda, in Franciacorta and in the Upper Valleys. This consequently led to an increase in cases of liver cirrhosis and liver cancer, especially if the unrecognized HCV virus was associated with a risky lifestyle and an inadequate diet, for example very fatty or with abuse of spirits. In the 2000s the liver problem in the area reached the alarm threshold and therefore various epidemiological studies were conducted to evaluate the prevalence of viruses in the Brescian population. And so a very large number of people with chronic hepatitis B and chronic hepatitis C have been identified.
What method did you follow to get in touch with the target population to be screened?
At a national level, projects have already started to test subjects at risk such as prisoners or people with addictions. FdS tried to intercept another segment of the population that had characteristics of risk, i.e. that of people from countries where the prevalence of the virus was higher, such as Eastern Europe (Russia, Ukraine, Moldova, Belarus, etc. .). Furthermore, FdS has decided to focus on those people who work in our homes, with the roles of domestic collaborators and carers.
What communication approaches have been adopted for the active involvement of these people?
Flyers written in different languages were created and we placed them in strategic places, even if people were then reached mainly through word of mouth.
How were the counseling and screening services provided to those who chose to join? How was the linkage to care managed?
Those who presented were given a rapid test for the detection of hepatitis C antibodies, the presence of which indicates that the patient has contracted the virus in his lifetime. In the event of a positive response, HCV RNA research was performed to assess whether the patient had the infection in progress. In case of positivity, people were accompanied to the treatment centers closest to their area to start the eradication treatment.
What are the results obtained?
Membership was important. It has been estimated that since 2020 about 27,000 men and about 63,000 women from Eastern Europe have lived in the Brescia area; calculating that the disease affects about 3-4% of the population, we estimated that there could be an incidence of at least 2,000 infected women and about 800 men in our area. About 350 people were tested. About 4% of people tested were infected.
What are the positive effects in terms of prevention and for the community as a whole?
The identification of the presence of the Hepatitis C virus makes it possible to prevent a whole series of problems related to the chronic pathology, with important benefits both for people’s health and in terms of costs and resources “that can be saved” by the National Health System. Hepatitis C is a major health concern because a person with severe liver disease has high care needs. This is why it is important to prevent its spread, especially now that we have available – since 2014 – new drugs to treat the disease, which have very high success rates, up to 98%. Those who undergo treatment also greatly reduce the risk of developing diseases related to Hepatitis C.