A high prevalence of viral hepatitis C in a socially excluded Roma community in Brno

Česká verze

Authors: S. Věchetová ^1,2; L. Krekulová ^1,3; Z. Oktábec ^1,2; V. Řehák ^1,2
Authors place of work: Remedis, s. r. o., Praha ¹; Klinika adiktologie, 1. lékařská fakulta, Univerzita Karlova a Všeobecná fakultní nemocnice v Praze ²; IV. Interní klinika, 1. lékařská fakulta, Univerzita Karlova a Všeobecná fakultní nemocnice v Praze ³
Published in the journal: Epidemiol. Mikrobiol. Imunol. 68, 2019, č. 3, s. 115-121
Category: Původní práce

Summary

Objectives: To conduct a pilot study to assess the prevalence of blood-borne and sexually transmitted diseases (STDs) in a socially excluded Roma community engaging in risky behaviours in Brno, Czech Republic.

Methods: Fifty subjects engaging in risky behaviours, of whom 35 self-reported to belong to the Roma ethnicity, were recruited while receiving treatment in a newly established addiction centre in Brno between March and December 2017. All subjects were tested for blood-borne diseases and STDs. Epidemiological and demographic data were collected by means of assisted interview at the time of the first contact.

Results: Forty-three (86%) of 50 participants were anti-HCV positive. Of 35 subjects from the Roma subgroup, 32 (91.5%) tested anti-HCV positive. Among the 43 anti-HCV positive subjects, 35 (81.4%) also showed HCV RNA positivity. Of the 32 anti-HCV positive in the Roma subgroup, 26 (81.3%) were HCV RNA PCR positive. Only HCV (hepatitis C virus) genotypes 1 (a,b) and 3 were detected in the study group. Nine Roma subjects (25.9%)were newly diagnosed with syphilis of which none of them was aware. All study patients were negative for anti-HIV 1,2.

Conclusion: As a proof of concept, this pilot study showed the importance of targeting epidemiological research and preventive care at excluded communities engaging in risky behaviours. The high anti-HCV seroprevalence in the Roma population in Brno who self-admitted intravenous drug use as well as the nine newly diagnosed cases of syphilis illustrate not only a high prevalence of risky behaviours in this excluded community but also the absence of systematic health care coverage in this population. A positive point is that when an appropriate model of care is used, even the Roma clients are willing and able to comply with the therapy. This is true of both viral hepatitis C and syphilis: thanks to close cooperation with addictology services and opiate substitution treatment, all nine patients successfully completed 2 weeks of anti-treponemal antibiotic treatment. More systematic work with socially excluded communities including specific models of care tailored to the needs of poorly compliant patients is an essential prerequisite for controlling HCV epidemics in the Czech Republic. An additional effect in the surveillance of other infectious diseases linked to risky behaviours can be considered as an added value.

Keywords:

Czech Republic – HCV – viral hepatitis C – PWID – infectious diseases – Roma – Brno

Zdroje

1. Nelson PK, Mathers BM, Cowie B, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. The Lancet, 2011;378(9791): 571–583. DOI: 10.1016/S0140-6736(11)61097-0. Dostupné na www: http://linkinghub.elsevier.com/retrieve/pii/S0140673611610970

2. Mohd Hanafiah K, Groeger J, Flaxman AD, et al. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology, 2013; 57(4):1333–1342. DOI: http://doi.org/10.1002/hep.26141

3. The World Health Organisation (WHO). Hepatitis C Fact Sheet. 2014. Dostupné na www: http://www.who.int/mediacentre/factsheets/fs164/en/index.html. Accessed 2 July 2018.

4. Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol, 2017;2: 161–176. DOI: http://doi.org/10.1016/S2468-1253(16)30181-9. Dostupné na www: http://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30181-9/fulltext

5. UNAIDS. Fact sheet – Latest statistics on the status of the AIDS epidemic. 2018. Dostupné na www: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf. Accessed 2 July 2018.

6. World Health Organisation (WHO). Global Health Sector Strategy on Viral Hepatitis 2016-2021: Towards Ending Viral Hepatitis. Geneva: World Health Organization, 2016. Dostupné na www: https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf?sequence=1.

7. Martin NK, Vickerman P, Miners A, et al. Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations. Hepatology, 2012;55(1):49–57. DOI: http://doi.org/10.1002/hep.24656.

8. Wandeler G, Dufour JF, Bruggmann P, et al. Hepatitis C: a changing epidemic. Swiss Medical Weekly, 2015;145:w14093. DOI: http://doi.org/10.4414/smw.2015.14093. Dostupné na www: http://smw.ch/article/doi/smw.2015.14093/.

9. Razavi H, Robbins S, Zeuzem S, et al. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. The Lancet: Gastroenterology & hepatology, 2017;2(5):325–336. DOI: 10.1016/S2468-1253(17)30045-6. Dostupné na www: http://linkinghub.elsevier.com/retrieve/pii/S2468125317300456.

10. Seidenberg A, Rosemann T, Senn O. Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real world setting. BMC Infectious Diseases, 2013;13(1):9. DOI: http://doi.org/10.1186/1471-2334-13-9. Dostupné na www: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548742/.

11. Grebely J, Bruggmann P, Backmund M, et al. Moving the Agenda Forward: The Prevention and Management of Hepatitis C Virus Infection Among People Who Inject Drugs. Clinical Infectious Diseases, 2013;57(suppl 2):S29–S31. DOI: http://doi.org/10.1093/cid/cit264. Dostupné na www: https://academic.oup.com/cid/article/57/suppl_2/S29/395032.

12. Mravčík V, Strada L, Reimer J, et al. Hepatitis C treatment uptake and adherence among injecting drug users in the Czech Republic. Epidemiologie, Mikrobiologie, Imunologie, 2014; 64(3):265–269.

13. Hepatitis Australia. 5 September 2018. Dostupné na www: http://www.hepatitisaustralia.com/. Access 2 July 2018.

14. Hajarizadeh B, Cunningham EB, Reid H, et al. Direct-acting antiviral treatment for hepatitis C among people who use or inject drugs: a systematic review and meta-analysis. 2018;3(11):754–767. DOI: 10.1016/S2468-1253(18)30304-2. Dostupné na www: https://linkinghub.elsevier.com/retrieve/pii/S2468125318303042.

15. Greberly J, Larney S, Peacock A, et al. Global, regional, and country-level estimates of hepatitis C infection among people who have recently injected drugs. Addiction, 2019; 114(1):150–166. DOI: 10.1111/add.14393. Dostupné na www: http://doi.wiley.com/10.1111/add.14393.

16. World Health Organization. Global hepatitis report, 2017. Geneva: World Health Organization, 2017. ISBN 978-92-4-156545-5. Dostupné na www: https://apps.who.int/iris/bitstream/handle/10665/255016/9789241565455-eng.pdf;jsessionid=C9466BE13389911B8050493811AEBD83?sequence=1.

17. Wiessing L, Ferri M, Grady B, et al. Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention. PLoS ONE, 2014;9(7). DOI: 10.1371/journal.pone.0103345. Dostupné na www: http://dx.plos.org/10.1371/journal.pone.0103345.

18. Hagan H, Pouget E R, Des Jarlais DC, et al. Meta-Regression of Hepatitis C Virus Infection in Relation to Time Since Onset of Illicit Drug Injection: The Influence of Time and Place. American Journal of Epidemiology, 2008;168(10):1099–1109. DOI: 10.1093/aje/kwn237. Dostupné na www: https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kwn237.

19. Page K, Morris MD, Hahn JA, et al. Injection Drug Use and Hepatitis C Virus Infection in Young Adult Injectors: Using Evidence to Inform Comprehensive Prevention. Clinical Infectious Diseases, 2013;57(suppl_2):S32–S38. DOI: 10.1093/cid/cit300. Dostupné na www: http://academic.oup.com/cid/article/57/suppl_2/S32/397297/Injection-Drug-Use-and-Hepatitis-C-Virus-Infection.

20. Morris MD, Shiboski S, Bruneau J, et al. Geographic Differences in Temporal Incidence Trends of Hepatitis C Virus Infection Among People Who Inject Drugs: The InC3 Collaboration. Clinical Infectious Diseases, 2017;64(7):860–869. DOI: 10.1093/cid/ciw869. Dostupné na www: https://academic.oup.com/cid/article/64/7/860/3052314.

21. Mravčík V (Ed.). Výroční zpráva o stavu ve věcech drog v České republice v roce 2017 [Annual Report on Drug Situation 2017 - Czech Republic]. Praha: Úřad vlády České republiky, 2018. ISBN 978-80-7440-219-7. Dostupné na www: https://www.drogy-info.cz/data/obj_files/32962/837/VZdrogy2017_web181207.pdf.

22. Kajanová A, Hajduchová H. Romská minorita a návykové látky v České republice a na Slovensku. Adiktologie, 2014;14(2):168–172.

23. Kouyoumjian SP, Chemaitelly H, Abu-Raddad LJ. Characterizing hepatitis C virus epidemiology in Egypt: systematic reviews, meta-analyses, and meta-regressions. Scientific Reports, 2018;8(1):1661 (published online). DOI: 10.1038/s41598-017-17936-4. Dostupné na www: http://www.nature.com/articles/s41598-017-17936-4

24. Ackelsberg J, Varma JK (coordinators). Hepatitis C in New York City: State of the Epidemic and Action Plan. NYC Health, 2013.

25. Němeček V, Částková J, Fritz P, et al. The 2001 serological survey in the Czech Republic – viral hepatitis. Cent Eur J Public Health, 2003;11, suppl.:S54–61.

26. Zábranský T, Mravčík V, Korčišová B, et al. Hepatitis C Virus Infection among Injecting Drug Users in the Czech Republic – Prevalence and Associated Factors. Eur Addict Res, 2006;12(3): 151–160.

27. Krekulová L, Řehák V, Oktábec Z, et al. HCV Genotype Shift Occurred Over the 15 years in PWIDs in the Czech Republic. Epidemiol Mikrobiol Imunol, 2019;1, 68(1):3–8.

28. Žlnayová E. Postavenie a úloha ženy – matky a muža – otca v rómskej rodine. Romano džaniben, 1996;3(1):29–41.

29. Mehta SH, Genberg BL, Astemborski J, et al. Limited uptake of hepatitis C treatment among injection drug users. J Community Health, 2008;33:126–133. DOI: 10.1007/s10900-007-9083-3. Dostupné na www: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800027/

30. Grebely J, Raffa JD, Lai C, et al. Low uptake of treatment for hepatitis C virus infection in a large community-based study of inner city residents. J Viral Hepat, 2009;16(5):352–358. DOI: 10.1111/j.1365-2893.2009.01080.x. ISSN 1352-0504.

31. Alavi M, Raffa JD, Deans GD, et al. Continued low uptake of treatment for hepatitis C virus infection in a large community-based cohort of inner city residents. Liver Int;34(8): 1198–1206. DOI: 10.1111/liv.12370. ISSN 1478-3223.

32. Státní zdravotní ústav Praha. Trendy vývoje a výskyt HIV/AIDS v ČR v roce 2017. Praha: Státní zdravotní ústav Praha, NRL pro HIV/AIDS, 2018. Dostupné na www: http://szu.cz/uploads/documents/CeM/HIV_AIDS/rocni_zpravy/2017/Tiskova_zprava_NRL_pro_HIV_AIDS_2017.pdf.

33. Bachofner J, Valli PV, Bergamin I, et al. Excellent outcome of direct antiviral treatment for chronic hepatitis C in Switzerland. Swiss Medical Weekly, 2018;148(34). DOI: 10.4414/smw.2018.14560. Dostupné na www: http://doi.emh.ch/smw.2018.14560.