2023-06-01 12:27:07
Much remains to be done to raise awareness of the importance of early testing for HIV and hepatitis B and C, especially among vulnerable populations in Europe. Early detection allows access to treatment and prevents disease transmission.
“HIV continues to affect the health and well-being of millions of people in Europe. Over the past decade, nearly 590,000 people in the European Union and European Economic Area (EU/EEA), and more than 2.3 million in the wider European region, have been diagnosed with HIV. Around 1 in 8 (or 12%) people living with HIV in the EU do not know their status,” said Andrea Ammon, director of the European Center for Disease Prevention and Control, ECDC). She was speaking at the launch of the European Testing Week spring campaign, an initiative that encourages local, health and political institutions to increase testing efforts and raise awareness of the benefits of earlier testing. hepatitis and HIV.
In 2021, 36% of patients living with HIV had levels of the virus that allowed its transmission due to them not being diagnosed or receiving treatment. The European Region of the World Health Organization reports that 50% of HIV diagnoses occur very late in the course of the disease, with a person living an average of 3 years before receiving a diagnosis. Jens Lundgren, director of the Center of Excellence for Health, Immunity and Infections in Denmark, cited a recent paper from 2023 showing that people who delay treatment following an HIV diagnosis are at a persistently higher risk of contracting a serious infection, whether or not related to AIDS, and to die. Thus, early diagnosis and access to treatment reduce the risk of health complications and improve the patient’s quality of life.
In the EU/EEA, around 3.6 million people are believed to be living with chronic hepatitis B and 1.8 million with chronic hepatitis C infection. Around 50% of those infected remain undiagnosed. If the diagnosis is too late, some patients will have cirrhosis and hepatocellular carcinoma at the time of diagnosis.
Sexually transmitted infections also affect a significant proportion of the population, which requires improved testing and diagnosis of these diseases.
Who should be screened?
“There is a big difference in terms of which populations are most affected, and this manifests itself differently, both nationally, between regions and within countries. So there is no one-size-fits-all approach,” said Anastasia Pharris, lead infectious disease expert at ECDC.
Men who have sex with men, injecting drug users, prisoners, sex workers, transgender people and migrant populations are at disproportionately higher risk of HIV and viral hepatitis infections. Some of these key populations should be screened every 6-12 months for hepatitis B and C, and every 3-12 months for HIV, depending on existing risk.
Testing strategies are often extended to prenatal screening clinics, and testing is done in specific geographic regions where the prevalence of one of these infections is high. Testing should be immediately considered for people with symptoms or biomarkers of HIV or hepatitis As a general rule, people who have been diagnosed with hepatitis B, hepatitis C or HIV should be screened a screening test for the other two diseases.
Members of high-risk groups and symptomatic people should be able to get tested in general medical clinics, hospitals, prisons, pharmacies and other healthcare facilities. Europe is currently leading the way by setting up drug tests within locally rooted organisations, which offer, for example, addiction and harm reduction services. “Self-screenings increased sharply between 2018 and 2022,” noted A. Pharris. Self-testing has seen huge success following being implemented as a strategy for a pilot project in Poland during the COVID-19 pandemic in 2020.
What should be done to improve screening?
J. Lundgren advocated for the development of integrated national testing strategies for HIV and hepatitis B and C. These diseases have common modes of transmission, often affect the same populations and require similar services from providers. of care.
However, only 37% of national guidelines include recommendations for integrated screening for HIV, viral hepatitis and sexually transmitted infections. The provision of integrated and voluntary testing services will increase detection rates for these viral infections.
Ann Sullivan, board member of the European AIDS Clinical Society, recommends that testing be part of routine care. For example, women might be educated regarding the importance and relevance of HIV and hepatitis testing at antenatal clinics. This is now standard practice in the UK and by 2021 over 99% of women who received antenatal care were tested. Emergency departments in areas with high HIV prevalence are also encouraged to perform HIV and hepatitis screening.
HIV and viral hepatitis are associated with social stigma, which often leads to a decrease in the number of tests carried out and a delay in diagnosis and treatment. Therefore, screening options should be tailored to individuals’ needs and preferences, and screening should take place in a welcoming and non-judgmental setting.
People shouldn’t be afraid of going to jail or being deported from their host country for asking for a test, which is still a problem in many countries, said Daniel Simões, head of the information at Coalition Plus, in Portugal. Screening carried out in local structures should be developed among the target populations and screening services should be free as far as possible.
Testing should also be done confidentially and patients should be able to opt out if they wish.
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