Spain has the opportunity to make history and become the first developed country to end a public health problem such as hepatitis C. A movement led by some of the greatest experts in our country in this infection and called «Hepatitis C Free Cities », #hepCityFree, It aims to prevent that opportunity from slipping between the fingers. To do this, it has decided to appeal to the commitment of the cities, "which are in a privileged position to give the definitive impulse to their elimination," says Javier García-Samaniego, coordinator of the AEHVE (Alliance for the Elimination of Viral Hepatitis in Spain).
García-Samaniego is one of the members of the Committee of Experts that is behind this initiative: a committee composed of hepatologists and specialists in Public Health, Microbiology and Infectious Diseases, Addictions and Primary Care, convinced of the privileged position of cities to give the final battle against hepatitis C
Since in April 2015, the National Strategic Plan for the Approach of Hepatitis C (PEAHC) in the National Health System (SNS) and until June 2019, they have been treated and cured with the new drugs more than 130,000 patients In our country.
However, despite these excellent results, it is estimated that in the area of the general population that passes through Primary Care there would still be some 35,000 people infected. Similarly, the diagnosis rate of the disease is not yet satisfactory: at least 22,500 people could be infected with the hepatitis C virus and not know it.
And to all of them we would have to add the people diagnosed who, for one reason or another, remain untreated. "In a nutshell, we are close, but if we do not travel the last leg to the finish line, we will lose the advantage achieved in the initial leg of the race," said Dr. García-Samaniego today.
Therefore, experts who are working on disposal projects in Spain warn that it is not enough to continue trying, but that it is necessary to develop new strategies to consolidate and improve the results already achieved and move quickly towards the challenge set by WHO for advanced countries to achieve elimination, a challenge that Spain could reach in 2023, according to the latest published studies.
In this effort, the contribution of cities is essential. With a high population density, cities represent the highest proportion of people living with hepatitis C virus. The risk and vulnerability to infection and reinfections are also greater in the urban environment and new cases are concentrated in their most disadvantaged neighborhoods, metropolitan areas and collectives, ”says Jeffrey V. Lazarus, another expert on the Committee on #hepCityFree, which has insisted on the privileged position of the big cities to accelerate the elimination and micro-elimination of the disease.
Lazarus is head of the research group in Health Systems of the Institute of Global Health of Barcelona (ISGlobal) and vice president of the international foundation of the European Association for the Study of the Liver (EASL), where he has developed the concept of the micro-elimination of hepatitis C.
With that purpose, to involve cities in the development of fundamental recommendations marked by AEHVE and the Spanish Association for the Study of the Liver (AEEH), the Committee of Experts that is behind «Cities Free of Hepatitis C” He has created a document of eight commitments to which he intends to add the largest possible number of Spanish cities and in particular to the large capitals ».
The document reflects, first, the importance of cities developing awareness campaigns to promote hepatitis C screening in the population between 40 and 70 years old, where most of the undiagnosed cases are concentrated. «This test, which should be done to this population at least once in a lifetime, has a very high diagnostic profitability, it is simple, cheap and is done only once, says Manuel Romero, Professor of Medicine at the University of Seville.
Because they concentrate the largest number of people living with the virus and do not know it
Because the populations at risk or vulnerable – Parenteral drug users, immigrant population, men who have sex with men, inmate population and former inmate … – are in greater proportion in cities.
And because the big hospitals and the social / health support devices (NGOs, addiction centers, STI centers, civic centers, social canteens …), prisons, are in the cities.
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