Background:
Migrants born in intermediate and high HBV and HCV-prevalence countries are likely to be at an increased risk for HBV and HCV infection. Data on HCV and HBV prevalence in migrants living in Italy are scanty and there are few screening and linkage-to-care programs for this target.
Methods:
A prospective, multicenter, based on the long-term active cooperation between two 3rd level units of Infectious Diseases and four 1st level clinical centers in southern Italy (Naples and Caserta) was designed. The study started in June 2018, was stopped in February 2020, and was resumed in February 2021 until November 2021. All migrants > 18 years old consecutively evaluated for clinical consultation at one of the first-level centers were enrolled. An anonymous serological screening was offered to seek HIV, HBV and HCV. The participants who were positive for a virus hepatitis infection and or for HIV were referred for linkage to cure at one of the tertiary units.
Results:
In the study period we observed 3,501 migrants; 3,417 (97.6%) agreed to be screened. Of the 3,417 subjects screened 185 (4.7%) were anti-HCV-positive, 334 (10%) were HBsAg positive, 61 (1.7%) HIV Ab positive. Of the 334 HBsAg positive subjects (figure 1), 116 (55%) had HBV DNA over than 2000 UI/ML. Of the 116 subjects with HBV DNA over than 2000 UI/ML, 111 (96%) had chronic hepatitis, 3 (2%) had cirrhosis and 2 (1.7%) had HCC; all subjects with HBV DNA over than 2000 UI/ML were linked to cure but 3 (2%) lost to follow up. Eight subjects (2%) were HDV Ab positive, but only one were HDV RNA positive, genotype 1 and was linked to cure. Of the 185 HCV ab subjects, 53 (29%) were HCV-RNA-positive. Of the 53 HCV-RNA-positive-subjects, 48 (90%) were linked to cure, 5 (10%) refused. Of these 48, 16 (33.3%) harboured HCV genotype 1b, 11 (22.9%) genotype 1a, 16 (33.3%) genotype 3, 3 (6.3%) genotype 4 and 2 (4.2%) genotype 2. All the 48 HCV-RNA-positive patients started DAA-regimen with sofosbuvir/velpatasvir and completed the 12 weeks of treatment. Of these 48 subjects, 47 (97.9%) showed a sustained virologic response (SVR) at 12 and at 24 weeks after treatment and one dropped-out in follow-up after finishing the DAA treatment.
Conclusions:
After an educational phase on the route of transmission and treatment availability, nearly 98% of subjects agreed to be screened and evaluated for hepatitis virus infections, so our model seems useful in the viral hepatitis screening, linkage-to-care and treatment in a difficult to manage population.
