Hepatitis Sector Strategy needs public health approach on epidemiological infection in São Paulo

The infectologist Cláudia Binelli during meeting in São Paulo 

The State of São Paulo Programme on Viral Hepatitis Eradication needs, immediately, an epidemiological screening, dealing with incidence, prevalence, treatment and inter alia databases, following theSUS (Brazilian Health Unified System) standard recommendation on process for developing guidelines.

Linked to “Alexandre Vranjac CVE (Epidemiological Surveillance Centre)” - State of São Paulo Health Surveillance Agency department, the State Programme on Viral Hepatitis does not have an appropriated public health approach in order to report the epidemiological database.

The departament has only internal editorials.

There are approximately 65 thousand people living with HCV infection in the State.

From June 29th to July 1st, the “I São Paulo’s Health Sector Strategy on HIV/AIDS Assembly” has taken place. The event was endorsed by FOAESP (State or São Paulo Forum on NGO/AIDS) and the three National Network of People Living with HIV/AIDS having real policy engagement in São Paulo.

During stakeholder consultation, activists from the four departments questioned the clinical Dr. Cláudia Binelli about viral hepatitis prevalence - especially about HCV infection and its HIV coinfection. Dr. Binelli is the spokeswoman of the State of São Paulo Programme on STD/AIDS.

Considering activists policy protests, the FOAESP has emailed four questions to the doctor.

The answers came from both Health Strategy Sectors: HIV/ AIDS and Viral Hepatitis ones.

The questions

1. Since 2014, the Epidemiological Report on STD/AIDS of the State of São Paulo does not bring epidemiological database on hepatitis B and C confection. Is there any intention on hiding information? Why coinfection databases were not provides on 2015 and 2016 editorial reports?

2. How many people living with HIV are coinfected by HCV in the state?

3. How many HIV/HCV-coinfected patients have already undertaken specific treatment and what is the percentage rate of cure of HCV on those patients?

4. How hepatitis C policy treatment is linked to the HIV/AIDS State Guidelines?

And the answers

Until 2014, the HIV/HCV coinfection database has been published on CVE’s (Epidemiological Surveillance Centre) report and in articles included in the Ministry of Health Editorial called “Epidemiology and Health Services”, since the State Programme on Viral Hepatitis/CVE lacks its own editorial report.

During 2014, the department has worked on a screening project with Dr. Wong Kuen (CRT-A) and the results of the epidemiological database have been published in the State Programme on HIV/AIDS Editorial and BEPA (State of São Paulo Epidemiological Report).

It is worth mentioning that the State Programme on Viral Hepatitis includes an epidemiological report editorial as part of its agenda, the database collected will have periodical briefing notes.

The Ministry of Health Development Protocol for Health Strategy Implementation (PCDT) on Hepatitis C and Coinfection prescribes that patients living with HCV/HIV confection must be prioritized on receiving suitable treatment for individuals undergoing antiretroviral treatment.

The HIV/HCV co-infected patient should be assessed to appropriated treatment, no matter the stage of its hepatic fibrosis.

Answering the HIV/HCV co- infection question, the HIV/HCV prevalence represents a major public health problem, with burden of 10% to 30% confection in several population.

People with HCV/HIV confection are in much higher risks of complication to cirrhosis or acute liver failure than HCV mono-infected individuals.

From 65.155 HCV-positive cases, there were 6.890 HCV/HIV cases of confection, the numbers shift positively from 15,6% (1.039/6.664) in 2007 to 10,2% (777/7.631) in 2016.

We are by the end of the Medex - Pharmaceutical Assistance Program of the State of São Paulo import department -databases analysis on chronic hepatitis C treatment, as well as its therapy progress and results, following PCDT- Clinical Protocol and Therapeutic Guidelines.

Once we have finished the study, we will provide a report.