Hepatitis C, about 6 million euros allocated in Emilia-Romagna for 2021/22
“The Emilia-Romagna region will have about 6 million euros available to start free screening of’hepatitis C. We have a great responsibility because it is a really important share of resources to be used in the best possible way. The economic breakdown provides about 2.5 million for the first year of operation; the remainder will be invested in the second year”. This was stated by Dr. Veronica Bernabucci, U.O.
Gastroenterology, University Polyclinic of Modena, speaking at the CME training course on the management of addicts with hepatitis C, organized by provider Letscom E3 with the nonconditional contribution of AbbVie.
Screening strategies and linkage to care in special populations
The course, entitled ‘Screening strategies and linkage to care in special populations. Where we stopped?’, is part of ‘Hand – Hepatitis in Addiction Network Delivery,’ the nationwide networking project sponsored by four scientific societies (SIMIT, FeDerSerD, SIPaD and SITD) that from 2019 involves Addiction Services and HCV Treatment Centers afferent to different Italian cities.
“We know very well,” Bernabucci added, “how the Decree Law we are discussing, the one that provided for the availability of these funds, has already framed and identified the populations towards which to direct the budget. The population is the general population, defined by birth cohort, specifically those born from 1969 to 1989. Our goal is to bring to the surface the underground of infections that we know are present and that escape us.
And we know well how much the populations of the Ser.D., so the people who rotate to these facilities that are very important to us, and the prison population are a pool of users where we can direct our efforts, economic and planning”.
“It is very important,” commented AOU of Modena General Director Dr. Claudio Vagnini, “that Modena is hosting a nationwide event such as today’s, on a highly topical issue. The Azienda that I direct is composed of two third-level hospitals that, thanks to the collaboration with the University, ensure the most innovative care and the most advanced research in many specialties, among which certainly hepatology has a long and fruitful tradition dating back to the hepatological school of Mario Coppo. An effective health care system, however, relies not only on large hospitals of excellence.
It relies on a comprehensive system of prevention and screening to intercept the patient as early as possible. Working, therefore, on at-risk groups is critical not only as a social challenge but is an important part of a community’s health policy.”.
Professor Erica Villa
Professor Erica Villa, director of the S.C. Gastroenterology – AOU of Modena, Polyclinic, added that ”as Dr. Vagnini recalled, the issue of “care,” of the population in general but even more so of the part of the population that can be defined as “fragile,” is an extremely important and complex issue. It is no coincidence that, precisely because of its complexity, despite several initiatives planned and hypothesized in the past, population screening programs with the resulting spillover in terms of a more comprehensive therapeutic offering, have not taken off with the effectiveness that would have been needed.
The advent of the Sars-Cov2 pandemic further played a negative role, overshadowing almost all care issues that were not hyper-urgent. Now that, thanks to the anti-Sars-Cov2 vaccination, the overall scenario is showing signs of returning to normal, it is finally time to resume programs that had been neglected.”
Dr. Chiara Gabrielli, Director of the Pathological Addictions Program of the province of Modena, also took part in the course, who focused on the initiatives to be put in place immediately with this funding and said that “the Decree gives us many elements to be able to work. Patient populations with pathological dependence, not only drug addicts but also people with alcohol or pathological gambling issues, are more vulnerable than those with Hcv infection. It’s therefore necessary not only to get tested. There is a very high testing rate within the region’s pathological addiction services: at least 72 percent of the population throughout Emilia-Romagna has been tested for Hcv within the pathological addiction services.
In recent years in Modena we have even reached levels of’80,’86 and’89 percent, while in prisons the percentage is over 95 percent”.
According to Gabrielli
According to Gabrielli“however, it is necessary to turn to other settings to perform more extensive screening. For example, on the roads, in neighborhood services. Therefore, we need to turn our attention to substance users even beyond pathological addiction services.
And in these settings, in these places to go and intercept people who consume substances, rapid testing is certainly of great use”.
Dr. Gabrielli then dwelt on the patients who are afferent to the Modena facility and those cured as a percentage thanks to treatment, pointing out that “on average in recent years there are about 10.000 people afferent to drug addiction services in the Emilia-Romagna region, while in the Modena area we assisted and took care of about 2.000 people. Many more people, however, are afferent even if only for advice or who, eventually, are not taken care of. Diagnosis testing for Hcv” is also possible for them;.
Gabrielli then disclosed
Gabrielli then disclosed that “people referred to our services have a very high percentage of Hcv infection, about 40 percent. So we are talking about thousands of individuals in the region and hundreds of people in the province of Modena. Many are those already undergoing treatment, and the cure rate is superimposed on that of the general population, so about 95 percent of those undergoing treatment recover.
It heals and can become infected again. So the Decree also asks us to work on counseling, prevention and reducing the possibility of reinfection”.
Instead, Dr. Bernabucci turned the spotlight on drugs, informing that “Emilia-Romagna has always been a virtuous region since the first availability of direct-acting antivirals. There’s been a historic shift from the old therapy to these drugs that are really effective, manageable and safe, with a really impressive speed of treatment. This is because we were very clear on who to treat”.
However, Bernabucci was keen to point out that “we have been on a downward trend since 2018, when treatments in the region were about 5.000/5.200, to drop dramatically in the first five months of 2021 to just over 500. Obviously, the setback and the slap in the face we have suffered from Covid, which has limited our action toward these patients but also the arrival of these patients to our facilities. However, I want to reiterate that the downward trend was already registered”.
But what to do today, particularly regarding the submerged?
“It’s estimated- continued Bernabucci- that in Emilia-Romagna there are 20.000/25.000 people to treat, 11.000/12.000 that revolve precisely in the’sphere of Ser.D. Precisely because it is submerged we cannot speak of precise numbers, we are lacking true epidemiological data.
Surely we are suffering and that is why we need to use these funds and this opportunity that is given to us. Italy is the only country in Europe that is able to have state funds specifically for its efforts on screening and eradication of hepatitis C” he concluded.