World Hepatitis Day: Experts call for accelerated screening efforts

RBreak down financial, social, and systemic barriers, including stigma, that hinder the elimination of viral hepatitis and the prevention of liver cancer caused by these infections.

This is the meaning of 'Hepatitis: Let's Break It Down', the message chosen by the World Health Organization (WHO) for the 2025 edition of the Hepatitis Awareness Day, celebrated every year on July 28.

In fact, although they are preventable, treatable and, in the case of hepatitis C, curable, viral hepatitis is "largely underrecognized" and silently causes liver damage, thus increasing the risk of developing liver failure, cirrhosis, and cancer. It is estimated that viral hepatitis causes approximately 1,3 million deaths worldwide each year.

Italy is one of the few countries in the world that has set aside a fund dedicated to free HCV (hepatitis C) screening, focusing on people treated by addiction services, prisoners, and the general population born between 1969 and 1989.

Screening progress data reveal a mixed picture: as of June 30, 2024, over 2.000.000 people had been tested, and nearly 15 active hepatitis C infections had been detected. Only 12% of the target general population had undergone a first-level hepatitis C test.

Among the regions that have activated screening to date, the highest coverage (40,3% of the target general population) was found in Emilia-Romagna. This leaves large segments of the population, especially those most vulnerable or those who have difficulty being reached by the national health service, or those with an estimated high prevalence of infection, excluded from diagnosis and treatment.

"Particular attention should be paid to screening for hepatitis C, which can identify this asymptomatic infection, which should be treated early, thus reducing the risk of virus transmission and disease progression," explains Antonio Gasbarrini, full professor of Internal Medicine at the Catholic University and scientific director of the Fondazione Policlinico Universitario Gemelli IRCCS in Rome. In Italy, it is estimated that over 300 people are still infected with hepatitis C, who are asymptomatic and therefore undiagnosed.

Expanded screening of the general population for hepatitis C would lead to a reduction in the number of deaths, 10 cases of hepatocellular carcinoma, and/or over 5.600 cases of liver failure over 3.500 years, compared to less efficient screening or simply a late diagnosis.

With a view to expanding screening and reaching some of these populations, the 'Test in the city' project was born, a screening and linkage to care initiative promoted by Gilead Sciences in collaboration with the Italian Fast Track Cities Network and Relab, which currently involves 14 cities and is aimed at migrant populations and people who use substances.

"The idea stems from the need to bring these people closer to the places they frequent, making it easier to get rapid tests for hepatitis C and B, and therefore also delta, and HIV," explains Paolo Meli, educationalist, president of the Don Giuseppe Monticelli Social Cooperative in Bergamo, and national coordinator of 'Test in the City'. "Each of the cities participating in the project offers free testing in a wide variety of settings: embassies and consulates, sporting events, places of worship, Provincial Adult Education Centers, and Special Reception Centers."

"The activities carried out so far have been a success: people have approached us with trust, and we have been able to address situations that would otherwise have remained unnoticed," Meli emphasizes, "ensuring them a healthcare pathway. This result confirms the project's underlying assumptions: that if we want to address public healthcare, we must focus on the most vulnerable populations. The third sector, capable of developing outreach initiatives that reach those living in vulnerable conditions or facing barriers to accessing services, can play a key role."

Thanks to the project, approximately 4.000 tests for HIV, HCV, and HBV have been performed so far. Approximately 2,48% of those tested tested positive for one or more infections; approximately 60% of those tested were between the ages of 20 and 40, and nearly two-thirds were male.

In cases where the test was positive, individuals were taken to a treatment center for a more specific test. Once the results were confirmed, a follow-up process was initiated in almost all cases. Those who tested positive for HBV have been or are currently being tested for HDV.

“The project also allowed us to validate innovative care pathways,” explains Miriam Lichtner, full professor of Infectious Diseases at Sapienza University of Rome. “It is necessary to collaborate with the communities living in the areas to understand what the most suitable methods and places are for offering screening, a participatory screening that aims to take charge and fight stigma.

Thanks to the proven effectiveness of rapid tests, we can now organize activities outside of healthcare settings and, always working with cultural mediators or community representatives, ensure immediate counseling and thus facilitate the care of those who test positive in treatment centers, breaking down barriers and facilitating access to the national healthcare system."

Thanks to funding for the screening campaign, Italy was one of the first countries to plan a strategy to achieve the WHO's goal of eradicating the infection by 2030. "But given the current situation, achieving this is unthinkable.

It is clear that more needs to be done: we know that the prevalence is higher in SERD and prisons and it is therefore there that we must continue to carry out the tests and extend them throughout the country - underlines Stefano Fagiuoli, director of the Complex Unit of Gastroenterology, Hepatology and Transplantology of the ASST Papa Giovanni XXIII of Bergamo and professor of Gastroenterology at the Department of Medicine and Surgery of the University of Milan Bicocca -

However, it is also important to promote opportunistic testing in hospitals, offering the test to patients admitted to departments other than gastroenterology or infectious diseases, or even involving general practitioners to understand how many of their patients have signed up for screening and offer it to those who have not yet signed up or have never taken the test.

These actions are "urgent, because where they have already been implemented, they have revealed that a third of those who tested positive not only had the infection but also advanced liver disease. The hope is that screening will not only be refinanced, given that not all the funds made available have been spent," Fagiuoli concludes, "but that the inclusion criteria and implementation strategies will be expanded."

Gilead's commitment to making viral hepatitis screening accessible to populations not covered by the national campaign also takes shape through its support for testing projects in several Italian centers, including hospitals and nursing homes.