2019 - 2024年意大利边缘化社区的乙肝病毒和丙肝病毒检测结果：一项前瞻性研究
HBV and HCV testing outcomes among marginalized communities in Italy, 2019-2024: a prospective study.
作者信息
Monti Monica, Caruso Teresita, Castellaccio Alice, De Giorgi Irene, Cavallini Gabriella, Manca Maria Laura, Lorini Serena, Marri Silvia, Petraccia Luisa, Madia Francesco, Stasi Cristina, Carraresi Laura, Lorefice Elisabetta, Bonelli Sara Irene, Nerli Alessandro, Mudalal Mouheb M A, Martini Lorenzo, Gitto Stefano, Carradori Eleonora, Xheka Adela, Bendini Irene, Lukolic' Samuele, Latella Lorenzo, Aquilini Donatella, Blanc Pierluigi, Zignego Anna Linda, Gragnani Laura
机构信息
MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, Firenze, Italy.
Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.
出版信息
Lancet Reg Health Eur. 2024 Dec 9;49:101172. doi: 10.1016/j.lanepe.2024.101172. eCollection 2025 Feb.
BACKGROUND
The health of the marginalized populations is crucial for public health and inequalities. The World Health Organization (WHO) Global Hepatitis Report 2024 stated that over 304 million people were living with Hepatitis B Virus (HBV)/Hepatitis C Virus (HCV) infection in 2022. We performed HBV/HCV screenings among marginalized communities to reveal hidden infections and link-to-care positive participants.
METHODS
From January 2019 to May 2024, finger-prick tests were used to conduct on-site screenings at non-profit organizations in Tuscany, Italy. Positive participants were referred to the closest outpatient clinic.
FINDINGS
Eighty/1812 (4.4%) participants were Hepatitis B surface Antigen (HBsAg)+, mostly men ( < ) and non-Italian natives compared to those HBsAg- ( < ). Fifty-two/1812 (2.9%) were anti-HCV+ with a higher proportion of Italians ( < ) and lower education level ( < 0.01) compared to the anti-HCV-. Intravenous drug use was an independent factor for being anti-HCV+ ( < ). Among the HBsAg + individuals, 66.3% (53/80) were linked and 90.4% (48/53) retained in care (treated/monitored). Of the anti-HCV participants requiring clinical evaluation, 37.8% (14/37) were linked to care, and all the 11/14 (88.6%) viremic patients were successfully treated.
INTERPRETATION
We found higher HBV/HCV positivity compared to national prevalences. Participation and linkage to care were successful. The young mean age (33.6 yrs) of HBsAg + individuals, primarily from regions with low vaccinal adherence, indicated geographical origin as a key risk factor. HCV positivity was associated with extreme marginality. The results stress the need to implement marginalized groups screening to target HBV/HCV hidden infections, reducing disparities in healthcare and advancing towards the WHO 2030 elimination goal.
FUNDING
Gilead Sciences; Fondazione Cassa di Risparmio di Pistoia e Pescia; Regione Toscana.
背景
边缘化人群的健康对公共卫生和健康不平等至关重要。世界卫生组织（WHO）《2024年全球肝炎报告》指出，2022年有超过3.04亿人感染乙型肝炎病毒（HBV）/丙型肝炎病毒（HCV）。我们在边缘化社区开展了HBV/HCV筛查，以发现隐匿感染并将检测呈阳性的参与者与医疗服务相联系。
方法
2019年1月至2024年5月，在意大利托斯卡纳的非营利组织进行现场筛查，采用手指采血检测。检测呈阳性的参与者被转诊至最近的门诊诊所。
结果
1812名参与者中有80人（4.4%）乙型肝炎表面抗原（HBsAg）呈阳性，与HBsAg阴性者相比，大多为男性（<）且非意大利本土居民（<）。1812名参与者中有52人（2.9%）抗-HCV呈阳性，与抗-HCV阴性者相比，意大利人的比例更高（<）且教育水平较低（<0.01）。静脉吸毒是抗-HCV呈阳性的一个独立因素（<）。在HBsAg阳性个体中，66.3%（53/80）与医疗服务相联系，90.4%（48/53）持续接受医疗服务（接受治疗/监测）。在需要临床评估的抗-HCV参与者中，37.8%（14/37）与医疗服务相联系，所有11/14（88.6%）病毒血症患者均成功接受治疗。
解读
我们发现HBV/HCV阳性率高于全国患病率。参与筛查并与医疗服务相联系的工作取得成功。HBsAg阳性个体的平均年龄较轻（33.6岁），主要来自疫苗接种依从性低的地区，表明地域来源是一个关键风险因素。HCV阳性与极度边缘化相关。结果强调需要对边缘化群体进行筛查，以发现HBV/HCV隐匿感染，减少医疗保健方面的差距，并朝着WHO 2030年消除目标迈进。
资助
吉利德科学公司；皮斯托亚和佩夏储蓄银行基金会；托斯卡纳大区。
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