the role of diagnosis and linkage to care - eu hcv policy ... · the role of diagnosis and linkage...
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The Role of Diagnosis
and
Linkage to Care
Rui Tato MarinhoMD, PhD, Gastroenterologist and Hepatologist
Vice-President Portuguese Society Gastroenterology
VHPB and UEG Member
ruitatomarinho@sapo.pt
The Liver Circle
Complex Medical Condition
AcuteHepatitis
ChronicHepatitis
CompensatedCirrhosis
DecompensatedCirrhosis
Liver
Cancer
Transplant
PalliativeCare
Dying
2014-20151989 19971991
2005FibroScan2001
80% PWID
~1-1,5%
HCV 3% world
96%
PLAN?
Lisbon
2010
Liver Unit and Outpatient
Benchmarking
HCV and PWIDs▪ All oral for All (Ministry of Health, ACSS, Infarmed)
▪ Doctors, others, HCP, with know-how (liver, HCV, PWID, HIV)
▪ Good liver transplant organization
▪ Legal System (Decriminalization)
▪ Patient Associations in the field (GAT, SOS, Fórum)
▪ PWID with support, facilities
▪ NGO (Ares do Pinhal, Crescer, CASO, others)
▪ Risk reduction approach (NSP, OST-methadone)
HCV - Diagnosis
Preventable/Curable
▪ Asymptomatic! 20-30% no risk factors
▪ Anti-HCV once in life
▪ Automatic confirmation RNA-PCR
▪ ALT as routine
▪ Priority – identify cirrhosis
Cancer 1-4%/year, varices, sepsis, transplant?
Helping a Lot
▪ GAT
▪ Ares do Pinhal
▪ Crescer
▪ CASO
▪ Abraço
▪ Liga Portuguesa Contra a SIDA
▪ AJPAS
▪ Fundação Portuguesa a Comunidade Contra a SIDA (CAOJ)
▪ SER+
▪ Casa Jubileu 2000
▪ SOS Hepatites
▪ Outras…
Complex > Simplex
▪ Setting Hospital
▪ Anti-HCV
▪ PCR hospital
▪ Fibroscan, etc
▪ Some Barriers
▪ Setting Local
▪ Anti-HCV rapid
▪ PCR local
▪ Fibroscan portable
▪ No Barriers
8 weeks DAA pangenotypic, safe, no Ribavirin
Pharma
NGO
Patients
Associations
Peers
Tests
HCV
NursesSocial
work
Prisons
Justice
Liver
Tx
DGS
Infarmed
SICAD
NHS
MOH
Person
HCV
pharmacists
ACSS
GPs Doctors
RR
OST
NSP
media
Parliament
Data
Registries
Universities
Futuring
cure, elimination, cure
▪ We want? Political and social decision
▪ Public Health National plan (executive, inclusive, global)
▪ Health and Justice Restauratives
▪ HCV is not only PWID (the stigma)
▪ HCV is liver, cirrhosis, risk of cancer (ad aeternum)
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