“The Emilia-Romagna Region will have approximately 6 million euros available to start free screening for 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 distribution foresees approximately 2 and a half million euros for the first year of activity, the remainder will be invested in the second year".
The Doctor stated this Veronica Bernabucci, Gastroenterology Unit, University Hospital of Modena, who spoke during the ECM training course on the management of drug addicts with hepatitis C, organized by the provider Letscom E3 with the unconditional contribution of AbbVie.
The course, entitled 'Screening strategies and linkage to care in special populations. Where did we stop?', is part of 'Hand – Hepatitis in Addiction Network Delivery', the national networking project sponsored by four scientific societies (SIMIT, FeDerSerD, SIPaD and SITD) which since 2019 has involved Addiction Services and HCV treatment centers in several Italian cities.
“We know well- added Bernabucci- how the Legislative Decree 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 one, defined by birth cohort, in particular the subjects born from 1969 to 1989. Our aim is to bring to the surface the submerged number of infections that we know are present and that escape us. And we know well how the populations of the Ser.D., therefore the subjects who rotate in these structures that are very important for us, and the prison population are a pool of users where to direct efforts, economic and planning”.
“It's very important – commented the General Director of the AOU of Modena, Dr. Claudius Vagnini – that Modena hosts a national event like today's, on a very topical theme. The Company that I manage is composed of two third-level hospitals that, thanks to the collaboration with the University, ensure the most innovative treatments and the most advanced research in many specialties, among which hepatology certainly has a long and fruitful tradition that dates back to the hepatology school of Mario Coppo.
An effective health system, however, is not only based on large hospitals of excellence. It is based on a complex system of prevention and screening that allows the patient to be intercepted as early as possible. Working on the categories at risk is therefore fundamental not only as a social challenge but is an important part of the health policy of a community”.
The teacher Erica Villa, Director of the Gastroenterology Department – AOU of Modena, Policlinico, 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 various initiatives planned and hypothesized in the past, population screening programs with the consequent impact in terms of a more complete therapeutic offer, have not taken off with the effectiveness that would have been necessary.
The advent of the Sars-Cov2 pandemic has further played a negative role, making almost all healthcare issues that were not hyper-urgent go into the background. Now that, thanks to the anti-Sars-Cov2 vaccination, the general scenario is showing signs of returning to normal, the time has finally come to resume the programs that had been neglected.”
Doctor also took part in the course Chiara Gabrielli, Director of the Pathological Addictions Program of the province of Modena, who focused on the initiatives to be implemented immediately with this funding and stated that “The Decree gives us many elements to work with. The populations of patients with pathological addiction, not only drug addicts but also people with alcohol problems or pathological gambling, are more vulnerable than those with HCV infection. It is therefore necessary not only to do the tests. Within the services for pathological addictions of the Region there is a very high percentage of tests: at least 72% of the population of the whole Emilia-Romagna has been tested for HCV within the services for pathological addictions. In recent years in Modena we have even reached levels of 80, 86 and 89%, while in prisons the percentage is higher than 95%”.
According to Gabrielli “However, it is necessary to turn to other settings to perform broader screening. For example, on the streets, in proximity services. Therefore, attention must be paid to people who consume substances even beyond the pathological addiction services. And in these settings, in these places where we go to intercept people who consume substances, rapid tests are certainly of great use”.
Doctor Gabrielli then focused on the patients who come to the Modena facility and on those who have recovered in percentage thanks to the therapies, underlining that “on average, in recent years, about 10.000 people have come to drug addiction services in the Emilia-Romagna region, while in the Modena area we have assisted and taken care of about 2.000 people. However, many more people come just for advice or are not taken care of. It is also possible for them to take the HCV diagnostic test”.
Gabrielli then made it known that “the people who come to our services have a very high percentage of HCV infection, about 40%. So we are talking about thousands of people in the Region and hundreds of people in the province of Modena. Many are those who have already started treatment and the percentage of recovery is comparable to that of the general population, so about 95% of people who undergo treatment recover. They recover and can get infected again. The Decree therefore asks us to also work on counseling, prevention and reducing the possibility of reinfection”.
Doctor Bernabucci instead turned the spotlight on drugs, informing that “Emilia-Romagna has always been a virtuous region since the first availability of direct-acting antivirals. There was a historic transition from the old therapy to these drugs that are truly effective, easy to handle and safe, with a truly impressive treatment speed. This is because we had a clear idea of who to treat”.
Bernabucci however wanted to point out that “we have been on a downward trend since 2018, when treatments in the Region were around 5.000/5.200, to drop dramatically in the first five months of 2021 to just over 500. Obviously, we suffered the setback and the slap from Covid, which limited our action towards these patients but also the arrival of these patients towards our facilities. However, I want to reiterate that the downward trend was already recorded”. But what to do today, especially with regard to the underground economy?
“It is esteemed- Bernabucci continued- that in Emilia-Romagna there are 20.000/25.000 people to treat, 11.000/12.000 who rotate right within the Ser.D. Precisely because it is a question of the submerged, we cannot speak of precise numbers, we lack real epidemiological data.
We are certainly suffering and for this reason we must use these funds and this opportunity that is given to us. Italy is the only country in Europe that can have state funds specifically for the commitment to screening and eradication of hepatitis C”he concluded.
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