Resilient HIV and HCV screening on the front line of communities in Portugal & Spain

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Blood-borne viruses include HIV and viral hepatitis B and C viruses, all of which people may carry in their blood and spread by various routes. These viruses are a public health challenge across the world, including in Europe.

According to data from the European Center for Disease Prevention and Control (ECDC), one in two people currently living with HIV is diagnosed late after being infected and an even larger proportion of the estimated 9 million Europeans living with chronic hepatitis B or C are not aware that they are infected1.

Screening is key to succeed in ending both the HIV and viral hepatitis epidemics. Whilst the COVID-19 pandemic has led to disruption in screening programs at various levels, there are efforts to ensure sustainability.

One such example is the FOCUS Program, a public health partnership initiative developed by Gilead Sciences in Spain and Portugal since 2018, to enable partners to develop and share best practices in blood-borne virus screening, diagnosis, and linkage to care in accordance with screening guidelines recommended by national, state and local public health authorities. EU FOCUS partners include hospitals, community health centers, community-based organizations, and other public health agencies that advance screening, diagnosis and link individuals to care.

FOCUS Program partners working on the front line of communities in Cascais (Portugal) and in Barcelona (Spain), met during a virtual FOCUS Program partner forum on November 19, 2020 to share lessons learned on blood-borne virus screening and linkage to care since the start of the COVID-19 pandemic. Both Iberian countries still struggle with the HIV epidemic, characterized by a high prevalence and high proportion of late diagnosis, with 45.9% and 49.7% of people living with HIV in Spain and Portugal diagnosed late.2,3

A small change in blood-borne virus screening is having a big impact

Hospital de Cascais was the first FOCUS Program partner in Europe. Reflecting on the hospital’s experience, Dr. Inês Vaz Pinto, head of HIV care, recalled “Changing our electronic health record allowed us to integrate screening in the normal patient clinical flow in the emergency department”. She continued to explain how the FOCUS Program enabled her team to diagnose people who were previously unaware of their infections and who would otherwise not have been tested.

A multidisciplinary team of healthcare professionals, hospital managers and IT specialists worked together to modify the hospital’s electronic health record system to automatically identify patients at the emergency department who are eligible for screening, in accordance with criteria set forth in official Portuguese guidance for HIV and HCV screening. The system was then used to automatically add HIV and hepatitis C serology tests to patient blood work processed for other reasons, and to alert the nursing staff to obtain oral patient consent for screening.

Dr. Vaz Pinto also commented on the program’s success in tackling late HIV diagnosis, which decreased from 91% to 42% among patients diagnosed with HIV at the emergency department. She ended by highlighting the approach’s resilience to withstand disruptive events such as the COVID-19 global pandemic.“Of course, COVID-19 has also had an impact on our screening project, but it never stopped”, Dr. Vaz Pinto adds. “[Screening] is already going up again and we are very excited with the results we’ve had so far”.

FOCUS Forum Program Partner Forum Nov 2020
Dr. Vaz Pinto, Hospital de Cascais (Portugal)

Job code: BE-HIV-2021-02-0001 Date of preparation: February 2021

 

Barcelona’s Hospital Universitari Vall d’Hebron implemented its enhanced blood-borne virus screening program in the emergency department in January 2020. Although hindsight would make this timing appear ill-fated, due to the COVID-19 pandemic, Professor María Butí, of the hospital’s gastroenterology department, could not disagree more. During the FOCUS meeting, she said “We have screened more than 6,000 individuals at our emergency department”.

She also stressed the importance of emergency physician engagement and training for the success of the project. Although the COVID-19 pandemic did have an impact on the screening program, Professor Butí is now looking at how best to incorporate the lessons learned from Cascais and other FOCUS partners in automating processes from the Electronic Health Record, to achieve higher sustainability of testing over time.

The Barcelona hospital also has its fair share of lessons learned to offer its peers: the medical team credits the implementation of single-step screening and diagnosis as a key element to succeeding with linkage to care. “Performing testing and confirmation of viremia [or virus detectable in the blood] in the same sample is extremely important for patients because they can, in a single visit, receive their diagnosis and be linked to care.” Professor Butí ended with a nation-wide call to action, “Spain needs to continue screening and diagnosing patients [for blood-borne viruses]”.

FOCUS Forum Program Partner Forum Nov 2020
Prof. María Butí, Hospital Universitari Vall d’Hebron, Barcelona (Spain)

Job code: BE-HIV-2021-02-0005 Date of preparation: February 2021

 

The policymaker’s perspective

Dr. Sara Cerdas, Member of the European Parliament and Public Health Expert provided concluding remarks after both partners’ presentations.“HIV and viral hepatitis are quite important because we are talking about previous epidemics that seem to have gotten lost as they turned into chronic management diseases”, the policymaker posits, “but we cannot forget this, and we must work together with Member States and different stakeholders to have a better perspective for [the screening of] such diseases”.

FOCUS Forum Program Partner Forum Nov 2020
Dr. Sara Cerdas, MEP (Member of the European Parliament)

Job code: BE-HIV-2021-02-0006 Date of preparation: February 2021

 

Dr. Cerdas stressed the importance of the recently approved EU4Health 2021-2027 plan — the European Union’s response to COVID-19 and its largest health program to date in monetary terms, at €5.1 billion in funding available to EU countries, health organizations and non-governmental organisations (NGOs).

The EU4Health plan confirmed EU interest in keeping communicable diseases, including HIV and viral hepatitis, on the policy agenda over the next few years.“HIV and viral hepatitis are on this package and there will be tools and instruments for better bottom-up approaches to achieve the WHO 2030 goals”, MEP Cerdas remarked.

“HIV must not be forgotten, viral hepatitis must not be forgotten,” Dr. Cerdas reinforces,“these are diseases with a huge burden not only for the individuals and societies but also for each member state”.

FOCUS Forum Program Partner Forum Nov 2020
Dr. Sara Cerdas, MEP (Member of the European Parliament)

Job code: BE-HIV-2021-02-0007 Date of preparation: February 2021