Reaching and testing those at risk of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) is still a public health challenge across Europe. One in two people currently living with HIV is diagnosed late in the course of their infection and an even larger proportion of the estimated 9 million Europeans living with chronic hepatitis B or C are not aware that they are infected. In order to interrupt existing transmission chains and prevent further infections, Europe needs a stronger focus on working closer with vulnerable populations to help better detect those with undiagnosed infections, then link them to appropriate health care services. Increasing testing coverage and uptake, especially for those most at-risk, is an essential element of any strategy to eliminate HBV, HCV and HIV in the European Union and European Economic Area (EU/EEA). To support Member States in their efforts to improve case detection and uptake of testing programmes as part of the global effort to eliminate viral hepatitis and HIV as public health threats by 2030, ECDC is providing this evidence-based guidance on integrated testing of hepatitis B (HBV), hepatitis C (HCV) and HIV.
The ECDC guidance on integrated testing of hepatitis B (HBV), hepatitis C (HCV) and HIV supports countries in the global effort to combat viral hepatitis and eliminate HIV as public health threats by 2030. At present, reaching and testing those at risk of infection with HIV, HBV or HCV is still a public health challenge across Europe.
An estimated nine million individuals are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) across the European Union/European Economic Area (EU/EEA), many of whom are undiagnosed. We performed a systematic review to identify interventions effective at improving test offerings and uptake in the EU/EEA. Original research articles were retrieved from PubMed and Embase databases in September 2017. Search strings combined terms for HBV/HCV, intervention, testing and geographic terms (EU/EEA). Retrieved publications were screened during a three-step selection process, in accordance with inclusion and exclusion criteria. A predefined set of variables was extracted from the included articles, and detailed summary tables were developed based on settings (i.e. healthcare versus community), testing intervention, and target population group. Outcomes of interest included test offerings, uptake, positivity rates, and patient and provider indicators of acceptability and feasibility. All included articles were assessed for quality. Out of 8 331 records retrieved, 93 studies were selected, including 15 conference abstracts. Included studies reported on testing initiatives in primary healthcare facilities (9), hospitals (12), other healthcare settings (31) and community settings (41). Testing initiatives targeted different population groups, for example migrants, people who use drugs, people in prison, pregnant women, but also the general population. Implementation of novel HBV/HCV testing approaches was associated with increased testing uptake in a number of settings, including drug services, pharmacies, and STI clinics. Community-based testing services were effective in reaching populations at a higher risk for infection, vulnerable and hard-to-reach populations. Our review identified several successful testing approaches in healthcare and community settings. Diversifying testing and offering a diverse set of testing opportunities (and making them part of the national testing strategy) may lead to a higher impact, both in terms of testing coverage and reduction of the undiagnosed fraction.
This report on hepatitis B and C presents the results of a survey in all EU/EEA countries. Twenty-two of the surveyed countries have already implemented universal vaccination programmes on hepatitis B for infants and adolescents, and half of the surveyed countries conduct screening programmes for hepatitis C, primarily for injecting drug users and prison inmates. Data on HBV and HCV screening policies, both for the general population and high-risk groups, remain sparse. The reports caution that predicting disease trends for viral hepatitis is extremely difficult as disease surveillance systems in Europe differ considerably. In addition, the asymptomatic nature of hepatitis C further complicates data interpretation. Possible readership: public health professionals, vaccination campaign managers, policy makers.
This evidence-based guidance is designed to inform the development, monitoring and evaluation of national HIV testing strategies or programmes in the countries of the European Union (EU) and the European Economic Area (EEA). It is intended to complement the following existing guidance: * Scaling up HIV testing and counselling in the WHO European Region as an essential component of efforts to achieve universal access to HIV prevention, treatment, care and support. Policy framework * European guideline on HIV testing * Guidance on provider-initiated HIV testing and counselling in health facilities * Guidance on testing and counselling for HIV in settings attended by people who inject drugs. Improving access to treatment, care and prevention. The evidence base to support this guidance has been provided by the findings and conclusions of a systematic literature search and evidence synthesis presented in the accompanying document HIV testing: Increasing uptake and effectiveness in the European Union. Evidence synthesis for Guidance on HIV testing. The points in this guidance are referenced, but for a fuller explanation of the rationale for the recommendations, readers are directed to the evidence synthesis.
The aims of the evidence synthesis are as follows: 1/ Provide an update of existing reviews and meta-analysis on individual and public health effects of HIV testing, taking into account publications on positive effects and benefits (e.g. earlier access to treatment, reduced transmission), the societal context of HIV testing (e.g. stigma), cost-effectiveness, and adverse effects; 2/ Provide a synthesis of the evidence for interventions, activities, programmes, and policies aimed at raising awareness of risk at the individual, community, societal and structural level; raising motivation of persons to be tested and of health professionals to offer HIV testing. The specific situations for risk groups and most vulnerable groups have to be taken into account; guarantee of high quality of the testing process itself (pre-test counselling, consent, opt-in/opt-out approaches, rapid tests, home testing, risk assessment, clinical indication, frequency of testing, guidelines and quality assurance); and follow up after HIV testing (post test counselling, referral to clinical and psychosocial care and support).
Testing strategies are central to the control of sexually transmitted infections (STIs), human immunodeficiency virus (HIV) and hepatitis B and C. Accurate testing enables treatment of those infected and subsequent reduction in infectiousness, reduced clinical consequences, identification as well as treatment of potentially infected partners and opportunities for health promotion and behaviour modification due to awareness of infection. Nonetheless, there is huge variation in the availability of current routine diagnostic tests within Europe. Recent changes in the field of testing for STIs, HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) include the widespread implementation of nucleic acid amplification technologies (NAATs) for chlamydia and gonorrhoea diagnosis and the development of HIV screening tests that are easy to use and give a result almost immediately.^Such technological advances can open up opportunities for more accurate, near-patient testing, provision of rapid results, or noninvasive sampling. Developments in communication technology in recent years have enabled the emergence of ehealth (electronic-health) and m-health (mobile-health) activities. A framework was developed to structure and categorise the advances and novel approaches, consisting of i) test technical principle and biological sample, ii) person-context, and iii) information cascade, together with the crosscutting themes of evaluation, regulation and quality control and quality assurance. A literature search was conducted using broad search criteria for recent publications from European countries, the United States, Canada and Australia. Further information and examples were obtained from grey literature and online searches and input from experts.^^Amplification, molecular techniques and non-amplification techniques such as lateral flow have been applied to test for a wide range of infections. Nucleic Acid Amplification Technologies (NAATs) tests offer accurate diagnosis, while lateral flow and flow-through tests require limited equipment, ease of use and can give results almost immediately. Rapidity together with the accuracy of molecular diagnostics has been made possible with the advent of microfluidic and nano-based NAATs technologies. Tests for chlamydia and gonorrhoea, and HIV viral load are in development. Microfluidic and nano-based technologies use very low reagent volumes which improve efficiency, reduce costs and increase portability. Non-amplification point of care (POC) tests for HIV based on lateral flow and flow-through principles have been extensively evaluated and implemented in service provision.^They enable screening results to be given to participants within 30 minutes and hence delivered at the same visit. However, development of POC devices and particularly any future self-testing devices will be challenged by the need for simple methods to collect the biological sample and apply it to the device, with minimal sample processing by the user to minimise operator error. Expanding testing for STIs, HIV, HBV and HCV to healthcare settings outside specialist health care services and community services can be used to expand access to testing and to target key populations. HIV and chlamydia testing are leading the way in moving testing to these types of venue. A systematic review reported that HIV testing in community settings can be successful in diagnosing previously undiagnosed HIV infections in many most at-risk populations, and is acceptable to both the target group and staff undertaking the tests.^^The use of the internet for recruiting young people or other target groups to test for STIs is considered to be the most innovative method of offering home-testing, offering convenience and privacy through postal receipt of kits while not limiting the target population by geographical location or the necessity of being registered with a healthcare organisation, school or other list. It is now common practice in many settings to disseminate results by SMS message, considerably reducing staff time for giving out results and managing clinic workload. An effective component of STI control strategies is partner notification and treatment: and there are a number of examples of internet tools which have been developed with the aim of helping both provider-led and patient-led partner notification. Evaluations of new diagnostics and new approaches to testing are required to ensure effective and cost-effective use and implementation of novel technologies and approaches.^Diagnostic devices are regulated at the EU-level under the Directive 98/79/EC of the European Parliament and of the Council of 27 October 1998 on in vitro diagnostic (IVD) medical devices, and the Commission Decision of 3 February 2009 amending Decision 2002/364/EC on common technical specifications for IVD medical devices. Although there are minimum performance standards for devices to detect HIV, HBV and HCV, these do not exist for other infections. Self-testing and POC IVD devices also fall under the scope of the European Directive and are additionally required to perform appropriately, given the skills and means available to the intended users, and the variation that can reasonably be anticipated in their technique and environment. The regulation of health-related mobile phone apps and websites is currently being debated in both Europe and the US. There is country specific legislation regulating the availability of POC diagnostic devices directly to the public.^Quality control of the production of commercially available diagnostic tests is regulated by CE-marking. Quality assurance and quality control of testing facilities however are not regulated at the European level. European countries may have their own accreditation scheme. New testing technologies combined with modern information and communication systems will enable the development of novel testing pathways. These novel approaches have the potential to improve access to, and hence uptake of, testing among individuals and population groups at risk as well as increase the proportion of infected individuals treated earlier in infection. These novel approaches will have clinical impact by improving the prognosis for those with infections as well as public health impact by reducing onward transmission and thus incidence and prevalence of infection.^^Research priorities for novel technologies for HIV, HBV, HCV and STI testing include: developing models, or frameworks, for strategic, evidence based decision making on adoption of novel approaches to testing; technology adoption type reviews of novel technologies and approaches; operational research on the implementation of testing programmes; and continued development and improvement of the technical aspects of testing devices.
Data, informatics, and technology are now among the most important aspects inspiring health professionals and informaticians to improve healthcare for the benefit of patients. This book presents the proceedings of the 19th annual International Conference on Informatics, Management, and Technology in Healthcare (ICIMTH 2021), held as a virtual event due to COVID-19 pandemic restrictions on 16 and 17 October 2021 in Athens, Greece. The ICIMTH conferences are a series of scientific events which bring together scientists working in the field of biomedical and health informatics from around the world. The 2021 conference examined the field of biomedical and health informatics in a very broad framework, presenting the research and application outcomes of informatics from cell to populations, and including a number of technologies such as imaging, sensors and biomedical equipment, as well as management and organizational aspects, including legal and social issues and the setting of research priorities in health informatics. A significant number of the papers included here relate to the COVID-19 pandemic. Providing an insight into the latest developments in biomedical and health informatics, the book will be of interest to all those working in the field.
BACKGROUND: Latent tuberculosis infection (LTBI), defined as a state of persistent immune response to prior-acquired Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB, affects about one-third of the world's population. Approximately 10% of people with LTBI will develop active TB disease in their lifetime, with the majority developing it within the first five years after initial infection. Currently available treatments have an efficacy ranging from 60% to 90%. Systematic testing and treatment of LTBI in at-risk populations is a critical component of WHO's eight-point framework adapted from the End TB Strategy to target pre-elimination and, ultimately, elimination in low incidence countries. OVERVIEW: Recognizing the importance of expanding the response to LTBI, in 2014 WHO developed Guidelines on the Management of Latent Tuberculosis Infection. The guidelines are primarily targeted at high-income or upper middle-income countries with an estimated TB incidence rate of less than 100 per 100 000 population, because they are most likely to benefit from it due to their current TB epidemiology and resource availability. The overall objective of the guidelines is to provide public health approach guidance on evidence-based practices for testing, treating and managing LTBI in individuals with the highest risk of progression to active disease. Specific objectives include identifying and prioritizing at-risk population groups for targeted intervention of LTBI testing and treatment, including defining an algorithm, and recommending specific treatment options. The guidelines are expected to provide the basis and rationale for the development of national guidelines for LTBI management based on available resources, epidemiology of TB including intensity of transmission, the health-care delivery system of the country, and other national and local determinants.
