Chronic hepatitis B virus (HBV) infection is a major public health threat for migrant populations in Spain and efforts to scale up testing are needed to reach the WHO elimination targets. The ...Hepatitis B Virus Community Screening and Vaccination in Africans (HBV-COMSAVA) study aims to use point-of-care testing and simplified diagnostic tools to identify, link to care, or vaccinate African migrants in Barcelona during the COVID-19 pandemic. From 21/11/20 to 03/07/2021, 314 study participants were offered HBV screening in a community clinic. Rapid tests for HBsAg screening were used and blood samples were collected with plasma separation cards. Patients received results and were offered: linkage to specialist care; post-test counselling; or HBV vaccination in situ. Sociodemographic and clinical history were collected and descriptive statistics were utilized. 274 patients were included and 210 (76.6%) returned to receive results. The HBsAg prevalence was 9.9% and 33.2% of people had evidence of past resolved infection. Overall, 133 required vaccination, followed by post-test counselling (n = 114), and linkage to a specialist (n = 27). Despite the COVID-19 pandemic, by employing a community-based model of care utilizing novel simplified diagnostic tools, HBV-COMSAVA demonstrated that it was possible to diagnose, link to care, and vaccinate African migrants in community-based settings.
Introduction
People living with HIV who are lost to follow‐up have a greater risk of health deterioration, mortality, and community transmission.
Objective
Our aim was to analyse both how rates of ...loss to follow‐up (LTFU) changed between 2006 and 2020 and how the COVID‐19 pandemic affected these rates in the PISCIS cohort study of Catalonia and the Balearic Islands.
Methods
We analysed socio‐demographic and clinical characteristics of LTFU yearly and with adjusted odds ratios to assess the impact of these determinants on LTFU in 2020 (the year of COVID‐19). We used latent class analysis to categorize classes of LTFU based on their socio‐demographic and clinical characteristics at each year.
Results
In total, 16.7% of the cohort were lost to follow‐up at any time in the 15 years (n = 19 417). Of people living with HIV who were receiving follow‐up, 81.5% were male and 19.5% were female; of those who were lost to follow‐up, 79.6% and 20.4% were male and female, respectively (p < 0.001). Although rates of LTFU increased during COVID‐19 (1.11% vs. 0.86%, p = 0.024), socio‐demographic and clinical factors were similar. Eight classes of people living with HIV who were lost to follow‐up were identified: six for men and two for women. Classes of men (n = 3) differed in terms of their country of birth, viral load (VL), and antiretroviral therapy (ART); classes of people who inject drugs (n = 2) differed in terms of VL, AIDS diagnosis, and ART. Changes in rates of LTFU included higher CD4 cell count and undetectable VL.
Conclusions
The socio‐demographic and clinical characteristics of people living with HIV changed over time. Although the circumstances of the COVID‐19 pandemic increased the rates of LTFU, the characteristics of these people were similar. Epidemiological trends among people who were lost to follow‐up can be used to prevent new losses of care and to reduce barriers to achieve Joint United Nations Programme on HIV/AIDS 95‐95‐95 targets.
Factors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with ...HIV.
We did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis.
We linked 20 847 (72·8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5·7%) people with HIV were diagnosed with SARS-CoV-2: their median age was 43·5 years (IQR 37·0-52·7), 131 (17·5%) were female, and 618 (82·5%) were male. 103 people with HIV (13·8%) were hospitalised, seven (0·9%) admitted to intensive care, and 13 (1·7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1·55, 95% CI 1·31-1·83), men who have sex with men (1·42, 1·09-1·86), and those with four or more chronic comorbidities (1·46, 1·09-1·97). Age at least 75 years (5·2, 1·8-15·3), non-Spanish origin (2·1, 1·3-3·4), and neuropsychiatric (1·69, 1·07-2·69), autoimmune disease (1·92, 1·14-3·23), respiratory disease (1·84, 1·09-3·09), and metabolic disease (2·59, 1·59-4·23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0·039) but no differences were observed in patients with undetectable HIV RNA (p=0·15).
People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes.
Fundació "la Caixa".
For the Catalan, Spanish and Russian translations of the Summary see Supplementary Materials section.
Reports on the impact of some antiretrovirals against SARS-CoV-2 infection and disease severity are conflicting.
We evaluated the effect of tenofovir as either tenofovir alafenamide/emtricitabine ...(TAF/FTC) or tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) against SARS-CoV-2 infection and associated clinical outcomes among people living with HIV (PLWH).
We conducted a propensity score-matched analysis in the prospective PISCIS cohort of PLWH (n = 14 978) in Catalonia, Spain. We used adjusted Cox regression models to assess the association between tenofovir and SARS-CoV-2 outcomes.
After propensity score-matching, SARS-CoV-2 diagnosis rates were similar in TAF/FTC versus ABC/3TC recipients (11.6% versus 12.5%, P = 0.256); lower among TDF/FTC versus ABC/3TC recipients (9.6% versus 12.8%, P = 0.021); and lower among TDF/FTC versus TAF/FTC recipients (9.6% versus 12.1%, P = 0.012). In well-adjusted logistic regression models, TAF/FTC was no longer associated with reduced SARS-CoV-2 diagnosis adjusted odds ratio (aOR) 0.90; 95% confidence interval (CI), 0.78-1.04 or hospitalization (aOR 0.93; 95% CI, 0.60-1.43). When compared with ABC/3TC, TDF/FTC was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.79; 95% CI, 0.60-1.04) or hospitalization (aOR 0.51; 95% CI, 0.15-1.70). TDF/FTC was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.79; 95% CI, 0.60-1.04) or associated hospitalization (aOR 0.33; 95% CI, 0.10-1.07) compared with TAF/FTC.
TAF/FTC or TDF/FTC were not associated with reduced SARS-CoV-2 diagnosis rates or associated hospitalizations among PLWH. TDF/FTC users had baseline characteristics intrinsically associated with more benign SARS-CoV-2 infection outcomes. Tenofovir exposure should not modify any preventive or therapeutic SARS-CoV-2 infection management.
Purpose of Review
The purpose of this review is using the currently available clinical and epidemiological data, to identify key aspects to improve both the clinical management and public health ...response with regard SARS-CoV-2/HIV co-infection among HIV vulnerable populations and people living with HIV (PLWH).
Recent Findings
While at the beginning of the COVID-19 pandemic, the lack of robust information on SARS-CoV-2/HIV coinfection prevented to have a clear picture of the synergies between them, currently available data strongly supports the importance of common structural factors on both the acquisition and clinical impact of these infections and the relevance of age, co-morbidities, and HIV viral load as associated worse prognosis factors among PLWH.
Summary
Although more information is needed to better understand the biological, clinical, and epidemiological relationship between both infections, in the meanwhile, syndemic approaches to prevent SARS-CoV-2 among HIV higher risk groups and PLWH, targeting these population for SARS-CoV-2 vaccines and protocolizing early identification of HIV + patients with worse COVID-19 prognosis factors, are crucial strategies to decrease the overall impact of SARS-CoV-2 /HIV coinfection.
It is unclear if SARS-CoV-2 has affected people living with HIV (PLWH) more.
We compared SARS-CoV-2 testing, test positivity, hospitalisation, intensive care unit (ICU) admission, and mortality ...between PLWH and the general HIV-negative population of Catalonia, Spain from March 1 to December 15, 2020.
SARS-CoV-2 testing was lower among PLWH 3556/13,142 (27.06%) compared to the general HIV-negative population 1,954,902/6,446,672 (30.32%) (p<0.001) but test positivity was higher among PLWH (21.06% vs. 15.82%, p<0.001). We observed no significant differences between PLWH and the general population in terms of hospitalisation (13.75% vs. 14.97%, p=0.174) and ICU admission (0.93% vs. 1.66%, p=0.059). Among positive cases, we found a lower mortality rate among PLWH compared to the general population (1.74% vs 3.64%, p=0.002).
PLWH tested less frequently for SARS-CoV-2, had a higher test positivity, similar ICU admission and hospitalisation rates, and lower SARS-CoV-2-associated mortality compared to the general HIV-negative population.
No está claro si el SARS-CoV-2 ha afectado más a las personas que viven con VIH (PVV).
Se compararon los test realizados de SARS-CoV-2, la positividad de la prueba, la hospitalización, los ingresos en la unidad de cuidados intensivos (UCI), las tasas de mortalidad entre PVV y la población general de Cataluña desde el 1 de marzo hasta el 15 de diciembre de 2020.
Los test realizados de SARS-CoV-2 fueron menos entre PVV 3.556/13.142 (27.06%) comparado con la población general de Cataluña 1.954.902/6.446.672 (30,32%) (p<0,001), pero la positividad de la prueba de SARS-CoV-2 fue mayor entre las PVV (21,06 vs. 15,82%; p<0,001). No se observaron diferencias estadísticamente significativas entre PVV y la población general en cuanto a hospitalizaciones (13,75 vs. 14,97%; p=0,174) e ingresos en la UCI (0,93 vs. 1,66%; p=0,059). Entre los casos positivos, se encontró una menor tasa de mortalidad entre las PVV en comparación con la población general (1,74 vs. 3,64%; p=0,002).
Las PVV fueron testadas menos frecuentemente por SARS-CoV-2 que la población general, tuvieron una tasa de positividad más elevada, tasas similares de hospitalización e ingresos en la UCI, y menos mortalidad asociada al SARS-CoV-2.
Chronic infection with HBV is responsible for >50% of all hepatocellular cancer cases globally and disproportionately affects sub-Saharan African (sSA) countries. Migration from these countries to ...Europe has increased substantially in recent years, posing unique challenges to health systems. The aim of this study was to carry out a community-based intervention to increase HBV screening, vaccination, and linkage to care among sSA migrants in Catalonia, Spain.
This was a prospective cohort study. Participants ≥18 years were offered community-based HBV screening between 20/11/20 and 21/01/22. Rapid HBV testing and blood sample collection utilizing plasma separation cards were carried out and linkage to care was offered to all participants. HBV vaccination and post-test counseling were performed at a second visit in the community. The main outcome was the odds of those with current HBV infection being successfully linked to hepatology. Rates of completing the care cascade of this model were analyzed.
In the present study, 444 people undergo screening, with 50.6% of participants showing evidence of past or current HBV infection, including an HBsAg prevalence of 9.2%. Migrants with current HBV infection exhibit 5.2 times higher odds of successful linkage to care compared to those in need of post-test counseling or vaccination. The study achieves a successful linkage to care rate of 72% for all participants, with specialist appointments arranged within 15.5 days.
This community-based HBV screening program provides evidence of a successful model for identifying and providing care, including vaccination, to west African migrants at high risk of HBV infection who may otherwise not engage in care.
This study aimed to report the prevalence and identify potential risk factors of chronic conditions among West African migrants living in the greater Barcelona area, Spain, and explore the ...relationship between years of residence in Spain and chronic disease burden.
This cross-sectional study included 436 adult African migrants who participated in a community-based hepatitis B virus (HBV) screening and vaccination program (HBV-COMSAVA) in the greater Barcelona area from 21 November 2020 to 22 January 2022. Data were analyzed using standard descriptive statistics and bivariable and multivariable logistic regression.
HBV, non-communicable diseases (NCDs) and metabolic risk factors, and multimorbidity prevalence were 9.17, 20.87, and 4.13%, respectively. Being male or having been previously tested for HBV were associated with higher odds of HBV positivity. Associated risk factors for NCDs and metabolic risk factors included living in Spain for >5 years, being female, and being aged ≥50 years.
The high prevalence of chronic conditions in migrant populations supports a need for early detection strategies and tailored public health interventions that aim to reduce the disease burden imposed on migrants and on health systems in host countries.
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