Julia del Amo’s research while affiliated with Ministry of Health, Madrid and other places

En esta editorial se presenta la situación actual del abordaje estrategico de la tuberculosis en España y se pone en valor el trabajo intersectorial en la prevención y el control de la tuberculosis.

BACKGROUND: HIV-related stigma in healthcare settings is recognised as a barrier to achieving positive health and well-being and is linked to negative healthcare outcomes. Data on HIV stigma in the healthcare setting has been lacking, and as a result the European Centre for Disease Prevention and Control and the European AIDS Clinical Society partnered to conduct the first ever European-wide HIV stigma survey. METHODS: A survey, translated into 38 languages, was developed and conducted from September 15 to December 5, 2023, targeting clinical and non-clinical professionals in healthcare settings. A non-probability sample was recruited via a multi-channel campaign, leveraging national healthcare professional networks and social media. The survey measured respondents' HIV-related knowledge and training, personal attitudes and behaviours towards people living with HIV (PLHIV). RESULTS: In total, 18,430 healthcare workers from 54 countries responded to the survey. Most respondents were female (74%) and occupied a variety of healthcare roles, although doctors (44%) and nurses (22%) were the most common. Knowledge about HIV on the concept of ‘undetectable equals untransmittable’ (U=U), post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (PrEP) varied across types of professional roles and health facilities, with many (69%) not agreeing with correct statements of HIV transmission and prevention. More than half of respondents would be worried when providing care to PLHIV, including drawing blood (57%) or dressing wounds (53%). Eight percent reported they would avoid physical contact and a quarter (26%) that they would wear double gloves when providing care to PLHIV. Twelve percent of healthcare workers preferred not to provide care to people who inject drugs, while 6% preferred not to provide care to men who have sex with men, sex workers, and transgender persons. Twenty-two percent reported having witnessed unwillingness to provide care, 19% witnessed disclosure of HIV status without consent, 18% poorer quality of care, and 30% discriminatory remarks or talking badly about PLHIV. CONCLUSIONS: This study identifies an urgent need for robust, multifaceted interventions, encompassing education and facility-levels to eliminate stigma, improve HIV knowledge among healthcare workers, and ensure equitable, non-stigmatizing care for all PLHIV, ultimately contributing to the global goal of ending the AIDS epidemic by 2030.

Objectives Sexually transmitted infections (STIs) have markedly increased over the last decade in Spain, calling for prevention and control innovative approaches. While there is evidence indicating the effectiveness of self-sampling for STI diagnosis, no kits for this purpose have been authorised in Spain. Methods A prospective single-blind cross-sectional study carried out between November and December 2022 in an STI clinic in Madrid, Spain, to determine the validity, feasibility and acceptability of self-sampling kits used by non-healthcare professionals from vagina, pharynx, rectum and urethra to diagnose Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Self-samples were compared with samples collected by healthcare professional (HC samples) and analysed by PCR. Frequency of CT and NG diagnosis by sample type was compared using McNemar’s test for paired data. Sensitivity and specificity of self-samples for CT and NG diagnosis were also calculated. Results 306 self-samples from 51 participants were analysed. 80% were men with median age of 33 (IQR: 28–38) years. Self-samples and HC samples showed no significant statistical differences in CT and NG diagnosis. Self-samples had a sensitivity of 81% for CT and 93% for NG, with a specificity of 97% for CT and 95% for NG. More than 90% of participants had no difficulty understanding the kit instructions and 71% expressed high levels of satisfaction with the self-sampling kit. Conclusion Self-sampling kits for CT and NG diagnosis can be safely and effectively used by non-healthcare professionals in Spain. National strategies for STI prevention and control should prioritise self-sampling strategies.

Introduction and Objectives The HepHIV 2023 Conference, held in Madrid in November 2023, highlighted how Europe is not on track to meet the United Nations (UN) sustainable development goals and Joint UN Programme on HIV/AIDS (UNAIDS) targets. This article presents the outcomes of the conference, which focus on ways to improve testing and linkage to care for HIV, viral hepatitis, and other sexually transmitted infections. HIV‐related stigma and discrimination, a major barrier to progress, was a key concept of the conference and on the agenda of the Spanish Presidency of the European Union. Methods The HepHIV 2023 organizing committee, alongside the Spanish Ministry of Health, oversaw the conference organization and prepared the scientific programme based on abstract rankings. Key outcomes are derived from conference presentations and discussions. Results Conference presentations covered the obstacles that HIV‐related stigma and discrimination continue to pose to access to services, models for data collection to better monitor progress in the future, and examples of legislative action that can be taken at national levels. Diversification of testing approaches was also highlighted, to reach key populations, (e.g. migrant populations), to increase testing offered in healthcare settings (e.g. emergency departments), and to account for different stages of epidemics across the region. Conclusion With a strong call for intensified action to address the impact of HIV‐related stigma and discrimination on testing uptake, the conference concluded that strengthened collaboration is required between governments and implementers around testing and linkage to care. There is also an ongoing need to ensure sustainable political commitment and appropriate resource allocation to address gaps and inequalities in access for key populations and to focus on the implementation of integrated responses to HIV, viral hepatitis, and sexually transmitted infections.

RESUMEN Los objetivos de desarrollo sostenible 10.2 y 10.3 ponen de manifiesto la importancia de fomentar la eliminación de leyes discriminatorias, así como de implantar políticas y prácticas orientadas a la inclusión social, económica y política de los grupos sociales vulnerables. En este sentido, abordar la discriminación y el estigma asociados al VIH sigue siendo una asignatura pendiente dentro de los países que conforman la Unión Europea. De ahí que esta cuestión haya sido una prioridad política de la Presidencia española del Consejo de la Unión Europea, reflejada en la Reunión de Alto Nivel VIH y derechos humanos. Acción política para alcanzar CERO estigma. En esta reunión se abordaron diferentes estrategias y acuerdos para promover la eliminación del estigma y la discriminación asociada al VIH en diferentes ámbitos y dimensiones sociales, políticas e institucionales.

Background Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019. Methods Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. Findings The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. Interpretation Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. Funding 10.13039/501100000805ECDC.