1,721,037 research outputs found
Addressing the hepatitis C care continuum: towards viral eradication
No full textHepatitis C virus (HCV) infection is a chronic disease which left untreated leads to cirrhosis, end-stage liver disease or hepatocellular carcinoma. Today HCV infection can be cured thanks to the development of direct acting antiviral (DAA) therapy. This provoked the World Health Organization to define targets to eliminate HCV infection as a public health threat by 2030. In order to reach these targets, the care for HCV infection needs to improve globally.
In this thesis, we focused on the care for HCV infection from a Belgian perspective. In part I, we studied the first step of the HCV care cascade in the general population: diagnosis. We performed a large seroprevalence study at the emergency department of a regional hospital (chapter 1). The prevalence of chronic HCV infection was 0.52%. People who used drugs, people who were ever imprisoned, and people immigrating from high-endemic countries should be screened in Belgium based on our findings. Furthermore, we assessed the current testing policy for viral hepatitis by general practitioners in Flanders, Belgium (chapter 2). This study clearly indicated the lack of an effective screening strategy. Only 1.8% and 1.6% of the total population were tested for hepatitis B surface antigen and HCV antibody, respectively. When screening was performed, this was mostly done in women of the reproductive age. Furthermore, only 7.9% and 9.9% of all patients with chronically elevated liver enzymes were tested for hepatitis B surface antigen and HCV antibody. Clearly more efforts are necessary to educate GPs on viral hepatitis and to stress the importance of screening for viral hepatitis in patients with elevated liver enzymes.
In part II, we focused on the care for HCV infection in people who inject drugs (PWID) in Belgium. PWID are currently the group most at risk to acquire the infection in Belgium, and they are underserved by the general health care. Firstly, we studied the influence of HCV infection on mortality in PWID and compared this to a control population of non-PWID with chronic HCV infection (chapter 3). In both groups, mortality was higher in patients with a chronic HCV infection, and curing the disease by therapy led to better standardized mortality ratios. As such, the benefits of HCV therapy for PWID were clear, although our findings are limited due to potential confounders and the retrospective nature. Furthermore, we demonstrated that DAA therapy was both safe and effective in two retrospective multicentre studies in Belgium (chapter 5). However, the availability of DAA treatment in itself is not enough to improve treatment uptake in PWID. We studied the current treatment uptake in PWID on opiate agonist therapy in a multicentre prospective study (chapter 6). Treatment uptake was low, and remained stable despite the availability of new DAA therapy during the study period. This was mostly due to the strict reimbursement criteria in Belgium. As these have been lifted as of the beginning of 2019, this would be the ideal time to study factors impeding treatment uptake in PWID. We also organized the care for HCV infection for PWID on opiate agonist therapy in Limburg. This led to a high uptake for screening, linkage to care and treatment uptake, although the latter was impeded by the reimbursement restrictions. Finally, we demonstrated that there is still a long way to go to improve on prevention, diagnosis and treatment of HCV infection in the European prisons
Addressing the hepatitis C care continuum: towards viral eradication
No full textHepatitis C virus (HCV) infection is a chronic disease which left untreated leads to cirrhosis, end-stage liver disease or hepatocellular carcinoma. Today HCV infection can be cured thanks to the development of direct acting antiviral (DAA) therapy. This provoked the World Health Organization to define targets to eliminate HCV infection as a public health threat by 2030. In order to reach these targets, the care for HCV infection needs to improve globally.
In this thesis, we focused on the care for HCV infection from a Belgian perspective. In part I, we studied the first step of the HCV care cascade in the general population: diagnosis. We performed a large seroprevalence study at the emergency department of a regional hospital (chapter 1). The prevalence of chronic HCV infection was 0.52%. People who used drugs, people who were ever imprisoned, and people immigrating from high-endemic countries should be screened in Belgium based on our findings. Furthermore, we assessed the current testing policy for viral hepatitis by general practitioners in Flanders, Belgium (chapter 2). This study clearly indicated the lack of an effective screening strategy. Only 1.8% and 1.6% of the total population were tested for hepatitis B surface antigen and HCV antibody, respectively. When screening was performed, this was mostly done in women of the reproductive age. Furthermore, only 7.9% and 9.9% of all patients with chronically elevated liver enzymes were tested for hepatitis B surface antigen and HCV antibody. Clearly more efforts are necessary to educate GPs on viral hepatitis and to stress the importance of screening for viral hepatitis in patients with elevated liver enzymes.
In part II, we focused on the care for HCV infection in people who inject drugs (PWID) in Belgium. PWID are currently the group most at risk to acquire the infection in Belgium, and they are underserved by the general health care. Firstly, we studied the influence of HCV infection on mortality in PWID and compared this to a control population of non-PWID with chronic HCV infection (chapter 3). In both groups, mortality was higher in patients with a chronic HCV infection, and curing the disease by therapy led to better standardized mortality ratios. As such, the benefits of HCV therapy for PWID were clear, although our findings are limited due to potential confounders and the retrospective nature. Furthermore, we demonstrated that DAA therapy was both safe and effective in two retrospective multicentre studies in Belgium (chapter 5). However, the availability of DAA treatment in itself is not enough to improve treatment uptake in PWID. We studied the current treatment uptake in PWID on opiate agonist therapy in a multicentre prospective study (chapter 6). Treatment uptake was low, and remained stable despite the availability of new DAA therapy during the study period. This was mostly due to the strict reimbursement criteria in Belgium. As these have been lifted as of the beginning of 2019, this would be the ideal time to study factors impeding treatment uptake in PWID. We also organized the care for HCV infection for PWID on opiate agonist therapy in Limburg. This led to a high uptake for screening, linkage to care and treatment uptake, although the latter was impeded by the reimbursement restrictions. Finally, we demonstrated that there is still a long way to go to improve on prevention, diagnosis and treatment of HCV infection in the European prisons
Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs
No full textHepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy of a known PWID cohort could improve uptake for screening and treatment.This trial was supported by Gilead Sciences. No direct or indirect benefits were granted to Gilead Sciences BVBA
Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs.
No full textIntroduction
Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy could improve uptake for screening and treatment for HCV in PWID.
Methods
We performed a prospective, interventional cohort study, evaluating the effect of case management on screening and treatment for HCV in PWID in an opiate substitution treatment (OST) setting in Limburg (Belgium). The goal was to address the PWID at this setting and to provide all the steps of the continuum of care, proposed by Meyer JP et al. (Int J Drug Policy, 2015). The cohort existed of four groups of PWID: firstly, a large group who received methadone at their local pharmacy. A second large group received methadone at the OST setting. Thirdly a smaller a group who were active users in a needle exchange program. And finally a small group who were recruited after referral to the hospital (former PWID).
Results
The results are presented in Figure 1. In all of the groups more than 80% of the cases were screened, except in the pharmacy group: these presented only a few times a year in the OST setting which could explain the lower screening rate. However, when addressed, more than 85% of the PWID in the pharmacy group were tested. In our PWID cohort, approximately 29% was HCV RNA positive. From these chronically infected PWID, 62% were assessed for treatment. 95% of them were eligible for antiviral treatment. However, treatment could only be started within the Belgian reimbursement criteria (requirement of F3 or F4 Metavir fibrosis score). As such, 51% were ruled out for therapy at present and treatment was started in 43%.
Conclusion
Case management is an effective way to screen a well-defined cohort of high-risk individuals for HCV and also improves treatment uptake
Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs
No full textHepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy of a known PWID cohort could improve uptake for screening and treatment.This trial was supported by Gilead Sciences. No direct or indirect benefits were granted to Gilead Sciences BVBA
Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs.
No full textIntroduction
Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy could improve uptake for screening and treatment for HCV in PWID.
Methods
We performed a prospective, interventional cohort study, evaluating the effect of case management on screening and treatment for HCV in PWID in an opiate substitution treatment (OST) setting in Limburg (Belgium). The goal was to address the PWID at this setting and to provide all the steps of the continuum of care, proposed by Meyer JP et al. (Int J Drug Policy, 2015). The cohort existed of four groups of PWID: firstly, a large group who received methadone at their local pharmacy. A second large group received methadone at the OST setting. Thirdly a smaller a group who were active users in a needle exchange program. And finally a small group who were recruited after referral to the hospital (former PWID).
Results
The results are presented in Figure 1. In all of the groups more than 80% of the cases were screened, except in the pharmacy group: these presented only a few times a year in the OST setting which could explain the lower screening rate. However, when addressed, more than 85% of the PWID in the pharmacy group were tested. In our PWID cohort, approximately 29% was HCV RNA positive. From these chronically infected PWID, 62% were assessed for treatment. 95% of them were eligible for antiviral treatment. However, treatment could only be started within the Belgian reimbursement criteria (requirement of F3 or F4 Metavir fibrosis score). As such, 51% were ruled out for therapy at present and treatment was started in 43%.
Conclusion
Case management is an effective way to screen a well-defined cohort of high-risk individuals for HCV and also improves treatment uptake
Hepatitis B virus prevalence and risk factors in hard-to-reach Turkish population living in Belgium: A protocol for screening
No full textBackground: Hepatitis B virus (HBV) infection is an important public health problem in the Turkish population, that is, one of the largest migrant populations in Europe. With the introduction of cost-effective antiviral treatments in the past decade, there is a need to identify HBV-infected patients who may benefit from treatment. This study describes the design of a study to assess the HBV prevalence in the Turkish population living in Belgium. Additionally, we will determine the risk factors of HBV infection and the uptake of screening, vaccination, and antiviral treatment in this hard-to-reach Turkish population. Methods: A longitudinal, epidemiological study will be conducted in the region Middle Limburg Belgium, where the Turkish adult population, 18 years of age and older, will be screened for hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and antibodies against hepatitis B core antigen (anti-HBc). Educational meetings concerning viral hepatitis B will be organized and there will be 3 ways to be screened for HBV: immediately after the educational meetings, at the Outpatient Hepatology Department of Ziekenhuis Oost-Limburg, and at home visits. Subsequently, participants will be asked to fill in a questionnaire regarding sociodemographic factors, migration history, risk factors for HBV infection (e.g., sharing toothbrushes, HBV-infected family member), and HBV vaccination status. Six months after screening, HBsAg-positive patients will be assessed whether they are under follow-up at the general practitioner or hepatologist. We will also gather information regarding the uptake of vaccination in nonimmunized subjects. Discussion: This study will provide information about the HBV prevalence and distribution of the stages of liver disease in the Turkish population in Belgium. By determining the risk factors for HBV infection, subgroups with an increased prevalence of HBV infection can be identified
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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