Hepatitis C virus (HCV) and HIV are major causes of worldwide disease. We aimed to evaluate the effect of a combined screening programme, which included a risk‐assessment questionnaire and rapid ...tests for point‐of‐care diagnosis, on screening and new diagnosis rates. This prospective, cluster randomized study was carried out in primary care. The intervention arm included a 4‐hour educational programme, the use of a risk‐assessment questionnaire and rapid tests. In the control centres, only the educational intervention was provided. The main variables compared were the screening coverage and the number and rate of new HCV and HIV diagnoses. Of a total of 7991 participants, 4670 (58.5%) and 2894 (36.2%) presented a risk questionnaire for HIV or HCV, respectively. The younger participants, men and those from Latin America and Eastern Europe, showed the greatest risk of presenting with a positive questionnaire. The overall screening coverage was higher within the intervention arm (OR 17.7; 95% CI 16.2‐19.5; P < .001). Only two HIV‐positives were identified compared to one in control centres. The rate of HCV diagnoses was higher among intervention centres, with 37 versus seven positive tests (OR 5.2; 95% CI 2.3‐11.6; P < .001). Of them, 10 were new diagnoses and 27 had been previously diagnosed, although not linked to care. In conclusion, a simple operational programme can lead to an increase in HCV and HIV screening rates, compared to an exclusively educational programme. The selection of at‐risk patients with a self‐questionnaire and the use of rapid tests significantly increased the diagnostic rate of HCV infection.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Estimar la prevalencia de la infección por VHC en la población general de un área sanitaria a través de una intervención en Atención Primaria, diferenciando entre nuevos diagnósticos e infecciones ...previamente diagnosticadas pero no tratadas.
Se seleccionaron participantes mediante un cuestionario de evaluación de riesgo, realizando un test rápido a todos aquellos con alguna respuesta afirmativa y a todos los mayores de 50 años. Las pruebas positivas se confirmaron en el laboratorio mediante determinación de anticuerpos frente al VHC por enzimoinmunoensayo de micropartículas quimioluminiscente y determinación de la viremia.
Del total de 7.991 participantes, el 36,2% presentó cuestionario de riesgo para VHC. Se realizaron 4.717 test, encontrando una proporción de anti-VHC de 0,65% en la población cribada, quedando en 0,46% de infecciones activas. El 51,9% de las personas con test positivo tenían un diagnóstico previo conocido pero no habían recibido tratamiento, por no ser conscientes de ello o no encontrarse vinculados al sistema sanitario, y el 19,2% tuvo un resultado positivo por primera vez. La prevalencia de infección oculta fue mayor en hombres, mayores de 50 años, y personas procedentes de Europa del Este.
Encontramos una prevalencia de infecciones activas superior a la descrita recientemente a nivel nacional, y con mayor porcentaje de pacientes nuevamente diagnosticados que en trabajos similares en otras áreas. Estas diferencias justifican la necesidad de realizar evaluaciones locales de la prevalencia de infección por VHC en cada una de las áreas de salud donde se plantee implementar y monitorizar un programa de microeliminación.
To estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously diagnosed but not treated.
Participants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay and determination of viraemia.
Of the 7,991 participants, 36.2% presented a positive HCV risk questionnaire. 4,717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe.
We found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.
OBJECTIVETo estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections ...previously diagnosed but not treated. METHODSParticipants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay and determination of viraemia. RESULTSOf the 7,991 participants, 36.2% presented a positive HCV risk questionnaire. 4,717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe. CONCLUSIONWe found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
to estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously ...diagnosed but not treated.
participants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay (CMIA) and determination of viraemia.
Of the 7991 participants, 36.2% presented a positive HCV risk questionnaire. 4717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe.
We found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.
estimar la prevalencia de la infección por VHC en la población general de un área sanitaria a través de una intervención en Atención Primaria, diferenciando entre nuevos diagnósticos e infecciones previamente diagnosticadas pero no tratadas.
se seleccionaron participantes mediante un cuestionario de evaluación de riesgo, realizando un test rápido a todos aquellos con alguna respuesta afirmativa y a todos los mayores de 50 años. Las pruebas positivas se confirmaron en el laboratorio mediante determinación de anticuerpos frente al VHC (anti-VHC) por enzimoinmunoensayo de micropartículas quimioluminiscente (CMIA) y determinación de la viremia.
Del total de 7991 participantes, el 36.2% presentó cuestionario de riesgo para VHC. Se realizaron 4717 test, encontrando una proporción de anti-VHC de 0.65% en la población cribada, quedando en 0.46% de infecciones activas. El 51.9% de las personas con test positivo tenían un diagnóstico previo conocido pero no habían recibido tratamiento, por no ser conscientes de ello o no encontrarse vinculados al sistema sanitario, y el 19.2% tuvo un resultado positivo por primera vez. La prevalencia de infección oculta fue mayor en hombres, mayores de 50 años, y personas procedentes de Europa del Este.
Encontramos una prevalencia de infecciones activas superior a la descrita recientemente a nivel nacional, y con mayor porcentaje de pacientes nuevamente diagnosticados que en trabajos similares en otras áreas. Estas diferencias justifican la necesidad de realizar evaluaciones locales de la prevalencia de infección por VHC en cada una de las áreas de salud donde se plantee implementar y monitorizar un programa de microeliminación.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic ...stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0–2) or unfavourable (score of 3–6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88–1.79,
p
= 0.1. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40–0.93,
p
= 0.022). The rates of patients with severe disability or death (mRS 5–6) were similar in cases and controls (30.5 versus 32.4 %,
p
= 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86–1.54),
p
= 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %,
p
= 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00–3.03,
p
= 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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