“Find the missing millions” and Hepatitis-free future are the themes of this year’s World Hepatitis Day (28 July), stressing the need to identify and diagnose those who are unaware of their viral hepatitis infection and link them to care. This is precisely what two major projects launched by ISGlobal, an institution supported by “la Caixa” Foundation, aim to do: improve hepatitis B screening and vaccination among Ghanaian and Senegalese migrants in Barcelona, and provide hepatitis C care to people who use drugs in the Balearic Islands. Both projects, led by ISGlobal researcher and Head of the Health Systems and Infectious Diseases Research Group, Jeffrey V Lazarus, obtained competitive funding from Gilead Sciences and are the only projects in Spain to have received funding in their categories.
Hepatitis B and Migrants in Barcelona
The hepatitis B (HBV) project will provide community-based HBV screening to West African migrant populations in the greater Barcelona area, and provide decentralized vaccination in collaboration with the local health authorities and linkage to care. “Being vaccinated against HBV provides protection against infection and is especially important for women, to protect themselves and their children,” says Camila Picchio, ISGlobal PhD researcher working on the project. “The project utilizes innovative methods to collect blood samples (like dried blood spots) and novel diagnostic tools, including rapid-detection tests, to facilitate a timely diagnosis, and is being led in conjunction with community members,” adds Lazarus. Identified patients who will require treatment and follow-up will be sent to Hospital Clínic de Barcelona (coordinated by Dr Sabela Lens) or Hospital Vall d’Hebron (coordinated by Dr Maria Buti) through an established referral system. The project, called HBV-COMSAVA, will be implemented in collaboration with the Public Health Agency of the Catalan Government (ASPCAT) who have marked a larger framework to test migrant populations across Catalonia. The Clinical Virology and Novel Diagnostic Research Group at the Germans Trias i Pujol Hospital, led by Elisa Martró, are simultaneously implementing community-based HCV screening initiatives among migrant populations from high-endemic countries, building on their previous successful work with Pakistani migrants (HepClink).
As Lazarus and colleagues state in an editorial published in the Journal of Hepatology on the occasion of this year’s World Hepatitis Day, the COVID-19 pandemic provides a unique opportunity to address vaccine hesitancy by promoting the benefits of a COVID-19 vaccine in particular, and of vaccination in general: “We must stress that HBV vaccination prevents a viral infection that can require lifelong treatment and can lead to liver cancer.” Current vaccination coverage rates are insufficient, particularly in sub-Saharan Africa and Asia. The global HBV birth dose vaccination coverage in 2015 was 38%.
Hepatitis C and people who use drugs in the Balearic Islands
The other study (Hep C Free Baleares) is a large-scale project that will be implemented in Mallorca, Menorca, and Ibiza and is the first ever study of its kind in the region. The project aims to eliminate HCV among people who use drugs on the islands and will focus on addiction service centers, a mobile methadone unit, and a prison to test and link people who use drugs to hepatitis C care and treatment by creating new pathways or improving existing ones, through the coordination with key stakeholders, including: the local health authorities, co-investigators Dr Maria Buti of Vall d’Hebron Hospital and Dr Angels Vilella of Son Llatzer Hospital in Mallorca, and project partners which include the Red Cross of the Balearic Islands, the NGO Projecte Home, and the Mallorca prison. The project has the support of other key stakeholders, including hepatologists, microbiologists, pharmacists, addiction specialists, and social workers.
On track for global elimination?
At the global level, most countries are not on track to meet the viral hepatitis elimination goals, as Lazarus and colleagues show in an analysis published in The Lancet Gastroenterology and Hepatology. The authors conducted an analysis where they created a ranking of countries according to their HBV and HCV policies. The analyses found that some countries had high policy scores but were not on track to meet the elimination targets, highlighting potential gaps between policy and implementation.
Lazarus JV, Picchio CA, Nayagam S, et al. Strengthening vaccine confidence during the COVID-19 pandemic: A new opportunity for global hepatitis B virus elimination. J Hepat. 2020.
Palayew A, Razavi H, Hutchinson SJ, Cooke GS, Lazarus JV. Do the most heavily burdened countries have the right policies to eliminate viral hepatitis B and C? Lancet Gastroenterol Hepatol. 2020
Additional new publications
- Winning the Race to eliminate hepatitis C: accelerating efforts together to reach the World Health Organization’s 2030 elimination targets. Boston Consulting Group, 2020.
- Cox AL, El-Sayed MH, Kao JH, Lazarus JV, Lemoine M, Lok AS, Zoulim F. Progress towards elimination goals for viral hepatitis . Nat Rev Gastroenterol & Hepatol, 2020.
- Lazarus JV, Negro F, El-Sayed M, Colombo M. A letter of solidarity during the COVID-19 pandemic. Liver Int, 2020.
- Palayew A, Stumo SR, Cooke GS, Hutchinson SJ, Jauffret-Roustide, Maticic M, Harris M, Metwally AM, Razavi H, Lazarus JV. The Hep-CORE policy score: a European hepatitis C national policy implementation ranking. PLoS ONE, 2020.
- Padrana A, Howell J, Scott N et al. Global Hepatitis C elimination: an investment framework. Lancet Gastroenterol Hepatol, 2020.