Hepatitis C test-and-treat program works for migrants in Italy: Study

A test-and-treat strategy was effective at identifying and treating hepatitis C among migrants and refugees in Italy coming from low-income countries where the condition may be more prevalent, a study found.

The results support the use of this strategy to reduce transmission of the hepatitis C virus (HCV), the cause of hepatitis C, and the occurrence of hepatitis C-associated liver complications in Italy and other countries with historically low hepatitis C rates.

This may help to achieve the World Health Organization’s goal to eliminate hepatitis C as a worldwide health issue by 2030.

Results from the program were published in the journal Infectious Diseases of Poverty in a study titled, “Effectiveness of test-and-treat model with direct-acting antiviral for hepatitis C virus infection in migrants: a prospective interventional study in Italy.”

Hepatitis C is a common type of hepatitis, or liver inflammation. It’s caused by an infection with HCV, which is transmitted via contact with infected blood and blood-containing bodily fluids. Without treatment, the infection can cause permanent liver scarring, or cirrhosis, liver cancer, and liver failure.

Reducing HCV circulation in Italy

While there isn’t a vaccine that can prevent HCV, there is a range of antiviral treatments that can usually clear the infection. Appropriately treating HCV requires first identifying the infection, however, and that can be hard in disadvantaged populations.

Italy has in recent years seen an influx in migrants and refugees, particularly from regions of sub-Saharan Africa. Although there isn’t a ton of data on hepatitis C prevalence among migrants in Italy, available data suggest a sizeable number of migrants are infected with HCV.

“Eliminating HCV among migrants will have a long-term positive impact from a public health and healthcare perspective by reducing the number of individuals who potentially develop HCV-related complications such as liver cirrhosis and [liver cancer] and reducing the circulation of HCV in the regions that host them,” the researchers wrote.

The team of researchers in Naples and Caserta devised a test-and-treat program that involved four phases. First, all adult migrants were provided educational resources about HCV, its mode of transmission, potential complications, and available treatment.

In the second phase, all migrants were offered hepatitis C diagnostic testing. Participants were first screened for antibodies against the virus, which indicates whether the patient has ever been infected. If positive, participants were then tested for the presence of HCV genetic material, which indicates an active infection.

In the third phase, patients who tested positive for active HVC infection were referred to a specialty center, and in the last phase they were offered Epclusa (sofosbuvir/velpatasvir), an antiviral oral therapy. Epclusa was provided to the program free of charge by its developer, Gilead Sciences, which partly funded the screening program.

Model effective for hard-to-reach population

The program, launched in 2018, involved six healthcare centers in Naples and Caserta, two cities in southern Italy that “host a large migrant population coming from low-income countries, especially from western Africa, middle and eastern Asia and Eastern Europe,” the researchers wrote.

The program was shut down in 2020 due to the COVID-19 pandemic, but was restarted for most of 2021.

A total of 3,501 migrants were evaluated, 58% of them from sub-Saharan Africa. Nearly all (97.6%) agreed to be tested for HCV. The inclusion of cultural mediators as part of the program likely contributed to the high rate of buy-in from migrant communities, the team noted.

A total of 185 of tested participants (4.7%) were positive for antibodies against HCV; none was aware of a previous or current HCV infection. Antibody-positive people were  older (31.5 vs. 27), and were more likely to come from Eastern Europe — especially Bulgaria, Romania, and Ukraine — than from Africa.

Of the 185 antibody-positive patients, 53 (28.6%) were positive for HCV genetic material, suggesting an active infection. Most of these patients were successfully referred to a specialty center for treatment, while five refused the referral.

All 48 referred patients received a 12-week course of Epclusa treatment. All but one completed a follow-up a few months later, and all of them were free from the infection at that point.

“Our model of HCV screening and linkage to care in target populations is effective in the HCV screening, linkage-to-care and treatment in a difficult-to-reach and to-manage population, such as undocumented migrants and refugees,” the researchers wrote.

“The program achieved outstanding success, probably because it was performed directly where the migrants were, that is, in humanitarian organizations, with free access even for migrants who did not have valid identification documents,” the team wrote, noting that these steps towards accessibility likely helped foster buy-in from the migrant communities and help build trust between migrants and medical staff.

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