Results of an integrated find-link-refer-treat initiative for HIV and
viral hepatitis in the Dobrogea region, Romania between 2010 and 2018
Ana-Maria Schweitzer, Mihaela Bogdan, Florentina Popa, Adelina Corduneanu, Iuliana Cicocea
Baylor Black Sea Foundation at Centrul Clinic de Excelenta “Spitalul Clinic de Boli Infectioase Constanta – Baylor College of Medicine – Texas Children’s Hospital –
Abbott Fund - AbbVie Foundation" ([email protected])
INTRODUCTION
• More than 65,000 people were tested for viral hepatitis and HIV since 2010, ensuring pre-
and post- counselling, informed consent and confidentiality measures, as well as accessibility
conditions (i.e. free of charge, no triage based on existence of health insurance or
inclusion in a specific target/risk group)
• Confirmed patients were enrolled in support services at Baylor (e.g. medical evaluations,
lifestyle assessment and interventions, provision of system navigation and free access to
support groups)
•
Figure 2. Age distribution of tested cases in Dobrogea (8 years)
Approximately 1500 patients with hepatitis B and C and approximately 300 patients
with HIV were enrolled
INITIATIVE OBJECTIVES
•
This initiative has two specific objectives:
•
•
To identify the prevalence of HIV, HBV and HCV in the general population in
Dobrogea
To improve the quality of life for people infected and affected by these
infectious diseases in Constanta and Tulcea counties (Figure 1)
Figure 3. HIV, HBV and HCV prevalence (voluntary counselling and testing programme)
Figure 1. The Dobrogea region of Romania
Prevalence (%)
HIV
Hepatitis B
Hepatitis C
SUCCESSES
• A long-term community partnership between the foundation, as a service provider, and the
local partners, as referral points for community members who can benefit from the VCT
programme (regional hospitals, general practitioners [GPs] and community leaders)
• Service is also a need for healthcare professionals (~2% of all persons tested are nurses or
doctors who do not have access to screening in the healthcare system)
• HIV and hepatitis counselling has significantly increased knowledge among participants
AIMS AND APPROACHES
•
The main approaches consisted of:
• Offering testing at pre-defined sites (testing offices in clinics) and one mobile
laboratory • Key support in the diagnosis process: >1500 patients with viral hepatitis received blood tests,
finalised the diagnosis process in less than a month and qualified for DAA treatment
• Creating a network of partners in the health system for referrals (as a partnership
between Local Health Authorities (LHAs), county hospitals and Baylor Romania) • • Creating wider awareness among the general public for self-referrals • Creating specific standards of care for enrolled cases to ensure follow-up and
continuity of treatment Consistent assessment of lifestyle habits with a potential impact on disease progression:
nutritional habits, management of side effects, sexuality, diagnosis disclosure, social support,
sleep (physical activity), drugs (tobacco, alcohol), system navigation, treatment,
homeopathy/herbal treatments/nutritional supplements and adherence
• Linkage with local gastroenterologist for correct medical follow-up and continuous
communication with the treating physician and GP
OUTCOMES
•
During 2010–2018, the programme was funded by the Abbott Fund and AbbVie Foundation,
with a total cost of approximately USD 2 million
CHALLENGES
• Continuity of financial support
More than 65,000 people have been tested to date (~1% of the total population of the
region), with a registered prevalence of 0.37 for HIV, 3.98 for HBV and 2.82 for HCV
(Figures 2 and 3); our programme is non-targeted, offering to the general population the
possibility for self-referral • Ensuring appropriate human resources and best practice, regardless of human resource
changes
• Creating a referral network to include GPs, doctors in county public hospitals and laboratories
• All pre- and post-test sessions were individual and face-to-face, and the communication
of results was confidential • Identification of gastroenterologists who are part of the public healthcare system and
who can offer support for patients free of additional charges
• More than 1500 patients with HBV and HCV enrolled in long-term services provided
by the Baylor Black Sea Foundation in Romania KEY LEARNINGS
•
• Approximately 300 patients with HIV were also linked with care
• Baylor provided psychosocial support that the state healthcare system does not offer:
• Depression screening
• Navigation support
• Blood tests that are not usually provided free of charge
• Assessment of lifestyle
• Behavioural change interventions
•
A public–private partnership is an essential approach to compensate for certain
weaknesses and gaps in the public health system through the ability of NGOs to be
flexible and respond quickly to a specific need and vulnerable group. However, a
programme of long-term services for patients with hepatitis is more expensive than the
standard VCT programme
REFERENCE
Schweitzer A-M, et al. HIV Medicine 2018;19(Suppl. 1):66–70.
This programme was funded by the Abbott Fund (2010–2013) and AbbVie Foundation (2014–present)
This poster has been prepared by the author(s) independently and reflects their own opinions, which are not necessarily those of Gilead Sciences Europe Ltd.
The ShareNow meeting has been organised and funded by Gilead Sciences Europe Ltd.
001/IHQ/18-2//1089ac, June 2018.