Impact of the 2008 economic crisis on the burden of hepatitis B and C diseases in Southern European countries.
Humans
Europe
/ epidemiology
Economic Recession
Hepatitis B
/ epidemiology
Cost of Illness
Incidence
Hepatitis C
/ epidemiology
Prevalence
Health Expenditures
/ statistics & numerical data
Female
Male
Hepatitis C, Chronic
/ epidemiology
Global Burden of Disease
/ trends
Hepatitis B, Chronic
/ epidemiology
Chronic liver diseases
Cirrhosis
Drugs
Economic crisis
Epidemiology
Global burden of disease
Hepatitis B
Hepatitis C
Liver cancer
Southern European countries
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
20 Jun 2024
20 Jun 2024
Historique:
received:
22
05
2023
accepted:
21
05
2024
medline:
21
6
2024
pubmed:
21
6
2024
entrez:
20
6
2024
Statut:
epublish
Résumé
The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may have affected ongoing efforts to eliminate viral hepatitis. This study was conducted to investigate the impact of the economic crisis on the burden of HBV and HCV disease. Global Burden of Diseases 2019 data were used to analyse the rates of epidemiological metrics of HBV and HCV acute and chronic infections in SWE and WE. Time series modelling was performed to quantify the impact of healthcare expenditure on the time trend of HBV and HCV disease burden in 2000-2019. Declining trends in incidence and prevalence rates of acute HBV (aHBV) and chronic HBV were observed in SWE and WE, with the pace of decline being slower in the post-austerity period (2010-2019) and mortality due to HBV stabilised in SWE. Acute HCV (aHCV) metrics and chronic HCV incidence and mortality showed a stable trend in SWE and WE, whereas the prevalence of chronic HCV showed an oscillating trend, decreasing in WE in 2010-2019 (p < 0.001). Liver cancer due to both hepatitis infections showed a stagnant burden over time. An inverse association was observed between health expenditure and metrics of both acute and chronic HBV and HCV. Epidemiological metrics for HBV and HCV showed a slower pace of decline in the post-austerity period with better improvement for HBV, a stabilisation of mortality and a stagnant burden for liver cancer due to both hepatitis infections. The economic crisis of 2008 had a negative impact on the burden of hepatitis B and C. Elimination of HBV and HCV by 2030 will be a major challenge in the SWE countries.
Sections du résumé
BACKGROUND
BACKGROUND
The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may have affected ongoing efforts to eliminate viral hepatitis. This study was conducted to investigate the impact of the economic crisis on the burden of HBV and HCV disease.
METHODS
METHODS
Global Burden of Diseases 2019 data were used to analyse the rates of epidemiological metrics of HBV and HCV acute and chronic infections in SWE and WE. Time series modelling was performed to quantify the impact of healthcare expenditure on the time trend of HBV and HCV disease burden in 2000-2019.
RESULTS
RESULTS
Declining trends in incidence and prevalence rates of acute HBV (aHBV) and chronic HBV were observed in SWE and WE, with the pace of decline being slower in the post-austerity period (2010-2019) and mortality due to HBV stabilised in SWE. Acute HCV (aHCV) metrics and chronic HCV incidence and mortality showed a stable trend in SWE and WE, whereas the prevalence of chronic HCV showed an oscillating trend, decreasing in WE in 2010-2019 (p < 0.001). Liver cancer due to both hepatitis infections showed a stagnant burden over time. An inverse association was observed between health expenditure and metrics of both acute and chronic HBV and HCV.
CONCLUSIONS
CONCLUSIONS
Epidemiological metrics for HBV and HCV showed a slower pace of decline in the post-austerity period with better improvement for HBV, a stabilisation of mortality and a stagnant burden for liver cancer due to both hepatitis infections. The economic crisis of 2008 had a negative impact on the burden of hepatitis B and C. Elimination of HBV and HCV by 2030 will be a major challenge in the SWE countries.
Identifiants
pubmed: 38902642
doi: 10.1186/s12889-024-18912-0
pii: 10.1186/s12889-024-18912-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1642Informations de copyright
© 2024. The Author(s).
Références
Sixty-Seventh World Health Assembly. 67th World Health Assembly Resolution on Hepatitis (WHA67.6). 2014;67.6(May):1–6. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA67-REC1/A67_2014_REC1-en.pdf .
World Health Organization. Global health sector strategy on viral hepatitis 2016–2021. Glob Hepat Program Dep HIV/AIDS. 2016;(June):56. Available from: http://apps.who.int/iris/bitstream/10665/246177/1/WHO-HIV-2016.06-eng.pdf?ua=1 .
Sixty-Ninth World Health Assembly. World Health Assembly resolution WHA69.11, Agenda item 13.2 on Health in the 2030 Agenda for Sustainable Development. Wha6911. 2016;(May). Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R11-en.pdf .
World Health Organization. Ensure healthy lives and promote well-being for all at all ages. 2016; Available from: https://www.who.int/sdg/targets/en/ .
World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 2016–2021: actions for impact. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. Available from: https://www.who.int/publications/i/item/9789240027077 .
GBD 2019 Hepatitis B Collaborators. Global regional and national burden of hepatitis B, 1990 – 2019 : a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol. 2022;1253(22):1–34.
Burns GS, Thompson AJ. Viral Hepatitis B: Clinical and Epidemiological Characteristics. Cold Spring Harb Lab Press. 2014;1–14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292086/pdf/cshperspectmed-HEP-a024935.pdf .
Blach S, Zeuzem S, Manns M, Altraif I, Duberg A-S, Muljono DH, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161–76. Available from: http://linkinghub.elsevier.com/retrieve/pii/S2468125316301819 .
Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61(1):S58–68. Available from: https://doi.org/10.1016/j.jhep.2014.07.012 .
Veracruz N, Gish RG, Cheung R, Chitnis AS, Wong RJ. Global trends and the impact of chronic hepatitis B and C on adjusted life years. Liver Int. 2022;42(June):2145–53.
doi: 10.1111/liv.15347
pubmed: 35753064
Veracruz N, Gish RG, Cheung R, Chitnis AS, Wong RJ. Global incidence and mortality of hepatitis B and hepatitis C acute infections, cirrhosis and hepatocellular carcinoma from 2010 to 2019. J Viral Hepat. 2022;29(December 2021):352–65.
Szczepanski M. A decade on from the crisis: Main responses and remaining challenges. European Parliament. 2019. Available from: https://www.europarl.europa.eu/RegData/etudes/BRIE/2019/642253/EPRS_BRI(2019)642253_EN.pdf .
Council on foreign Relations. The Eurozone in Crisis. 2015. Available from: https://www.cfr.org/backgrounder/eurozone-crisis .
Serapioni M, Hespanha P. Crisis and Austerity in Southern Europe: Impact on Economies and Societies. e-cadernos CES [Online]. 2019;31.
Italian Ministry of Health. Statistics yearbook 2019. 2019. Available from: https://www.istat.it/it/files//2019/12/Asi-2019.pdf .
Legido-Quigley H, Karanikolos M, Hernandez-Plaza S, de Freitas C, Bernardo L, Padilla B, et al. Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal. Health Policy (New York). 2016;120(7):833–9. Available from: https://www.sciencedirect.com/science/article/pii/S0168851016300860 .
Sakellarides C, Castelo-Branco L, Barbosa P, Azevedo H. European Observatory on Health Systems and Policies. The impact of the financial crisis on the health system and health in Portugal. 2014. Available from: https://www.euro.who.int/__data/assets/pdf_file/0006/266388/The-impact-of-the-financial-crisis-on-the-health-system-and-health-in-Portugal.pdf .
Vlachadis N, Kornarou E. Increase in stillbirths in Greece is linked to the economic crisis. BMJ. 2013;346. Available from: https://www.bmj.com/content/346/bmj.f1061 .
Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. Eur J Public Health. 2013Feb;23(1):103–8.
doi: 10.1093/eurpub/cks035
pubmed: 23132877
Costa G, Marra M, Salmaso S, Gruppo AIE su crisi e salute. Health indicators in the time of crisis in Italy. Epidemiol Prev. 2012;36(6):337—366. Available from: http://europepmc.org/abstract/MED/23293258 .
Santana P, Costa C, Cardoso G, Loureiro A, Ferrão J. Suicide in Portugal: Spatial determinants in a context of economic crisis. Health Place. 2015;35:85–94. Available from: https://www.sciencedirect.com/science/article/pii/S1353829215001033 .
Fountoulakis KN, Savopoulos C, Siamouli M, Zaggelidou E, Mageiria S, Iacovides A, et al. Trends in suicidality amid the economic crisis in Greece. Eur Arch Psychiatry Clin Neurosci. 2013Aug;263(5):441–4.
doi: 10.1007/s00406-012-0385-9
pubmed: 23223905
De Vogli R, Marmot M, Stuckler D. Excess suicides and attempted suicides in Italy attributable to the great recession. J Epidemiol Community Health. 2013 Apr 1;67(4):378 LP – 379. Available from: http://jech.bmj.com/content/67/4/378.1.abstract .
European Centre for Disease Prevention and Control. Risk assessment on HIV in Greece. Stockholm: ECDC; 2012. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/20121130-Risk-Assessment-HIV-in-Greece.pdf .
Kondilis E, Giannakopoulos S, Gavana M, Ierodiakonou I, Waitzkin H, Benos A. Economic Crisis, Restrictive Policies, and the Population’s Health and Health Care: The Greek Case. Am J Public Health. 2013;103(6):973–9. Available from: https://doi.org/10.2105/AJPH.2012.301126 .
European AIDS treatment Group. The impact of economic austerity on the HIV response in Portugal: a community perspective. 2014. Available from: https://www.gatportugal.org/public/uploads/tomadasposicao/Country%20Brief_Portugal%20EN.doc.pdf .
Abbafati C, Machado DB, Cislaghi B, Salman OM, Karanikolos M, McKee M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.
doi: 10.1016/S0140-6736(20)30925-9
Abbafati C, Machado DB, Cislaghi B, Salman OM, Karanikolos M, McKee M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223–49.
doi: 10.1016/S0140-6736(20)30752-2
World Bank. Current health expenditure (% of GDP) - Italy, Greece, Spain, Portugal. Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=IT-GR-ES-PT .
Ganesan M, Poluektova LY, Kharbanda KK, Osna NA. Human immunodeficiency virus and hepatotropic viruses comorbidities as the inducers of liver injury progression. World J Gastroenterol. 2019;25(4):398–410.
doi: 10.3748/wjg.v25.i4.398
pubmed: 30700937
pmcid: 6350175
Stevens GA, Alkema L, Black RE, Boerma JT, Collins GS, Ezzati M, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet. 2016;6736(16):30388–9. Available from: http://gather-statement.org .
The Institute for Health Metrics and Evaluation. Global Burden of Disease Study 2019 (GBD 2019) Data Resources. 2019. Available from: source: http://ghdx.healthdata.org/gbd-2019 .
R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: https://www.r-project.org/ .
World Health Organization. Hepatitis C - Key facts. 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c .
World Health Organization. Hepatitis B - Key facts. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b .
Global Burden of Disease 2016 Greece Collaborators. The burden of disease in Greece, health loss, risk factors, and health financing, 2000–16: an analysis of the Global Burden of Disease Study 2016. Lancet Public Heal. 2018;3:e395-406.
doi: 10.1016/S2468-2667(18)30130-0
Papatheodoridis G. Epidemiology of hepatitis B and D in Greece. 2008. Available from: http://www.vhpb.org/files/html/Meetings_and_publications/Presentations/ATHS41.pdf .
European Centre for Disease Prevention and Control. The sustainable development goals and hepatitis B and C in the EU/EEA. ECDC: Stockholm. 2021;(March). Available from: https://www.ecdc.europa.eu/en/publications-data/hepatitis-b-and-c-sustainable-development-goals-eu-eea .
Organisation for Economic Co-operation and Development. Health Statistics 2021. Health Care Utilisation 2019 Survey. 2021. Available from: https://oe.cd/ds/health-statistics .
Gazzetta Ufficiale della Repubblica Italiana. Legge 27 maggio 1991, n. 165. Available from: https://www.gazzettaufficiale.it/atto/stampa/serie_generale/originario .
Instituto de Salud Carlos III. Protocolos de la Red Nacional de Vigilancia Epidemiológica. Protocolo de vigilancia de la Hepatitis B. Versión 1 de junio de 2013. Revisado el de 3 de septiembre de 2016. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/PROTOCOLOS/PROTOCOLOS EN BLOQUE/PROTOCOLOS_RENAVE-ciber.pdf.
Direção-Geral da Saúde. Programa nacional para as hepatites virais. 2017. Available from: https://www.dgs.pt/documentos-e-publicacoes/relatorio-do-programa-nacional-para-as-hepatites-virais-2017.aspx .
European Blood Alliance. Italy. Available from: https://europeanbloodalliance.eu/country/italy/ .
Zuccaro O, Tosti ME, et al. Epidemiology of acute viral hepatitis in Italy: results of the surveillance through SEIEVA (Sistema Epidemiologico Integrato dell’Epatite Virale Acuta). Rapporti ISTISAN 12/4. 2012. Available from: https://www.iss.it/documents/20126/45616/12_4_web.pdf/36d495ed-ee41-8ef7-24d3-67d33aee6789?t=1581095228731 .
Ministero della Sanità. Decreto Ministeriale 15 dicembre 1990 Sistema informativo delle malattie infettive e diffusive. Gazzetta Ufficiale del 8 gennaio 1991, n. 6. 1991. Available from: https://www.epicentro.iss.it/infettive/pdf/DM_151290.pdf .
Ministerio de Sanidad. Orden SSI/445/2015, de 9 de marzo, por la que se modifican los anexos I, II y III del Real Decreto 2210/1995, de 28 de diciembre, por el que se crea la Red Nacional de Vigilancia Epidemiológica, relativos a la lista de enfermedades de declaración obligato. 2015. Available from: https://www.boe.es/buscar/doc.php?id=BOE-A-2015-2837 .
Bulteel N, Partha Sarathy P, Forrest E, Stanley AJ, Innes H, Mills PR, et al. Factors associated with spontaneous clearance of chronic hepatitis C virus infection. J Hepatol. 2016Aug;65(2):266–72.
doi: 10.1016/j.jhep.2016.04.030
pubmed: 27155531
Watanabe H, Saito T, Shinzawa H, Okumoto K, Hattori E, Adachi T, et al. Spontaneous elimination of serum hepatitis C virus (HCV) RNA in chronic HCV carriers: a population-based cohort study. J Med Virol. 2003Sep;71(1):56–61.
doi: 10.1002/jmv.10448
pubmed: 12858409
Manns MP, Wedemeyer H, Cornberg M. Treating viral hepatitis C: Efficacy, side effects, and complications. Gut. 2006;55(9):1350–9.
doi: 10.1136/gut.2005.076646
pubmed: 16905701
pmcid: 1860034
Papatheodoridis G. Aiming towards hepatitis C virus elimination in Greece. Ann Gastroenterol. 2019;32(4):321–9.
pubmed: 31263353
pmcid: 6595935
Gruppo multidisciplinare sui farmaci per l’epatite C cronica della Regione Emilia-Romagna. Nuovi antivirali diretti nella terapia dell’epatite C cronica. 2016. Available from: https://salute.regione.emilia-romagna.it/ssr/strumenti-e-informazioni/ptr/archivio/atti-regionali-e-documenti-ptr/229-epatite-c-cronica-giugno-2016 .
Direção-Geral da Saúde. Tratamento da Hepatite C Crónica no Adulto. 2017;028:1–44. Available from: https://www.dgs.pt/.../norma-n-0282017-de-28122017-pdf.aspx%0A .
Ministerio de sanidad igualdad y asuntos sociales. Plan estratégico para el abordaje de la hepatitis c en el sistema nacional de salud. Ministerio de Sanidad, Servicios Sociales e Igualdad. 2015. Available from: https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/hepatitisC/PlanEstrategicoHEPATITISC/docs/plan_estrategico_hepatitis_C.pdf .
Kondili L, Quaranta MG, Ferrigno L, Galli M, Andreoni M, Puoti M, et al. Eliminazione dell’epatite C cronica in italia: strategie di screening gratuito. Vol. 34, Istituto Superiore di Sanità. 2021.
Papatheodoridis G, Sypsa V, Kantzanou M, Nikolakopoulos I, Hatzakis A. Estimating the treatment cascade of chronic hepatitis B and C in Greece using a telephone survey. J Viral Hepat. 2015;22(4):409–15.
doi: 10.1111/jvh.12314
pubmed: 25209157
Estirado Gómez A, Justo Gil S, Limia A, Avellón A, Arce Arnáez A, González-Rubio R, et al. Prevalence and undiagnosed fraction of hepatitis C infection in 2018 in Spain: results from a national population-based survey. Eur J Public Health. 2021Dec;31(6):1117–22.
doi: 10.1093/eurpub/ckab069
pubmed: 34392348
Rumgay H, Arnold M, Ferlay J, Lesi O, Cabasag CJ, Vignat J, et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022;77(6):1598–606.
doi: 10.1016/j.jhep.2022.08.021
pubmed: 36208844
pmcid: 9670241
Kramer JR, El-serag H, Taylor TJ, White D, Frayne S, Cao Y, et al. HCV-related complications are increasing in women veterans: A national cohort study. 2017;24(11):955–65.
Forns X, Colom J, García-Retortillo M, Quer JC, Lens S, Martró E, et al. Point-of-care hepatitis C testing and treatment strategy for people attending harm reduction and addiction centres for hepatitis C elimination. J Viral Hepat. 2022Mar;29(3):227–30.
doi: 10.1111/jvh.13634
pubmed: 34806812
World Health Organization. Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. Available from: https://www.who.int/publications/i/item/9789240052390 .
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Statistical Bulletin 2017. 2017. Available from: http://www.emcdda.europa.eu/data/stats2017 .
Urbanus AT, Van De Laar TJW, Geskus R, Vanhommerig JW, Van Rooijen MS, Schinkel J, et al. Trends in hepatitis C virus infections among MSM attending a sexually transmitted infection clinic; 1995–2010. AIDS. 2014Mar;28(5):781–90.
doi: 10.1097/QAD.0000000000000126
pubmed: 24832014
European Centre for Disease Prevention and Control. Hepatitis C. In: ECDC. Annual epidemiological report for 2019. Stockholm. ECDC; 2021. 2021. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/AER-Hepatitis-C-2019.pdf .
Garriga C, Manzanares-Laya S, de Olalla P García, Gorrindo P, Lens S, Solà R, et al. Evolution of acute hepatitis C virus infection in a large European city: Trends and new patterns. PLoS One. 2017;12(11).
doi: 10.1371/journal.pone.0187893
pubmed: 29135988
pmcid: 5685589
Midgard H, Weir A, Palmateer N, Lo Re V, Pineda JA, Macías J, et al. HCV epidemiology in high-risk groups and the risk of reinfection. J Hepatol. 2016;65(1):S33–45. Available from: https://doi.org/10.1016/j.jhep.2016.07.012 .
van de Laar TJW, Matthews GV, Prins M, Danta M. Acute hepatitis C in HIV-infected men who have sex with men: an emerging sexually transmitted infection. AIDS. 2010Jul;24(12):1799–812.
doi: 10.1097/QAD.0b013e32833c11a5
pubmed: 20601854
Jin F, Dore GJ, Matthews G, Luhmann N, Macdonald V, Bajis S, et al. Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021 Jan 1;6(1):39–56. Available from: https://doi.org/10.1016/S2468-1253(20)30303-4 .
Hellenic Ministry of Health. Hellenic National Plan for the Management of Hepatitis C. 2017. Available from: http://www.moh.gov.gr/articles/ministry/grafeio-typoy/press-releases/4865-ethniko-sxedio-drashs-gia-thn-antimetwpish-ths-hpatitidas-c .
Saúde J e S-G da S de EA e da J e do S de EA e da. Despacho n.
Lazarus JV, Safreed-Harmon K, Thursz MR, Dillon JF, El-Sayed MH, Elsharkawy AM, et al. The Micro-Elimination Approach to Eliminating Hepatitis C: Strategic and Operational Considerations. Semin Liver Dis. 2018;38(3):181–92.
doi: 10.1055/s-0038-1666841
pubmed: 29986353
Giuliani R, Casigliani V, Fornili M, Sebastiani T, Freo E, Arzilli G, et al. HCV micro-elimination in two prisons in Milan. Italy : A model of care. 2020;27(12):1444–54.
Fiore V, Matteis G De, Ranieri R, Saderi L, Pontali E, Muredda A, et al. HCV testing and treatment initiation in an Italian prison setting : A step-by-step model to micro-eliminate hepatitis C. Int J Drug Policy. 2021;90:103055. Available from: https://doi.org/10.1016/j.drugpo.2020.103055 .
Cuadrado A, Llerena S, Cobo C, Pallás JR, Mateo M, Cabezas J, et al. Microenvironment Eradication of Hepatitis C : A Novel Treatment Paradigm. 2018;113(11):1639–48.
Jiménez-galán G, Alia-alia C, Vegue-gonzález M, García-berriguete RM, Fernández-rodríguez C, González-fernández M, et al. The contribution of telemedicine to hepatitis C elimination in a correctional facility. 2019;111(7):550–5.
Cuadrado A, Cobo C, Mateo M, Blasco AJ, Cabezas J, Llerena S, et al. Telemedicine efficiently improves access to hepatitis C management to achieve HCV elimination in the penitentiary setting. Int J Drug Policy. 2021;88:103031. Available from: https://www.sciencedirect.com/science/article/pii/S0955395920303698 .
World Health Organization. Improved access to health services to eliminate hepatitis C in Portuguese prisons. 2018. Available from: https://www.euro.who.int/en/health-topics/Health-systems/health-workforce/news/news/2018/8/improved-access-to-health-services-to-eliminate-hepatitis-c-in-portuguese-prisons# .
Secretaría General de Sanidad y Consumo Ministerio de Sanidad, Consumo y Bienestar Social. Plan Estratégico para el Abordaje de la Hepatitis C en el Sistema Nacional de Salud (PEAHC). 2018. Available from: https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/hepatitisC/PlanEstrategicoHEPATITISC/docs/Plan_Estrategico_Abordaje_Hepatitis_C_(PEAHC).pdf .
World Health Organization. New Report Highlights Global Progress on Reducing HIV, Viral Hepatitis and Sexually Transmitted Infections and Signals Need for Renewed Efforts to Reach 2030 Targets. 2021. Available from: https://www.who.int/news/item/20-05-2021-new-report-highlights-global-progress-on-reducing-hiv-viral-hepatitis-and-sexually-transmitted-infections-and-signals-need-for-renewed-efforts-to-reach-2030-targets .
Wingrove C, James C, Wang S. The impact of COVID-19 on hepatitis services and civil society organisations. Lancet Gastroenterol Hepatol. 2021 Sep 1;6(9):682–4. Available from: https://doi.org/10.1016/S2468-1253(21)00263-6 .
World Health Organization. Second round of the national pulse survey on continuity of essential health services during the COVID-19 pandemic: January-March 2021. Interim report. 2021. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS-continuity-survey-2021.1 .
World Health Organization. Third round of the global pulse survey on continuity of essential health services during the COVID-19 pandemic: November–December 2021. Interim report 7. 2022. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2022.1 .