Researchers from the Universities of Pisa and Florence have monitored the incidence of hepatitis B (HBV) and C (HCV) infections among the most marginalised communities in Tuscany through a series of multi-year screening campaigns on these populations, finding much higher prevalences than the national average and in subjects of a very young age.
In addition, thanks to collaboration and direct contact with care units in Florence, Empoli, Prato and Pistoia, positive cases had access to clinical care and, if necessary, treatment. The study, called “HBV and HCV testing outcomes among marginalised communities in Italy, 2019-2024: a prospective study”, was recently published in the journal “The Lancet Regional Health – Europe”, with corresponding author Laura Gragnani, researcher at the Department of Translational Research and New Technologies in Medicine and Surgery at the University of Pisa, and first author Monica Monti of the MaSVE Centre at the University of Florence. The study was funded by Gilead Science, Fondazione Cassa di Risparmio di Pistoia e Pescia and Regione Toscana.
The corresponding author Laura Gragnani.
Between 2019 and 2024, with a pause due to the COVID-19 pandemic, the research team tested markers of HBV (HBV surface antigen - HbsAg) and HCV infection (anti-HCV antibodies) in 1,812 individuals attending soup kitchens, reception centres and Italian language schools for foreigners in the metropolitan areas of Florence, Prato and Pistoia. The study found out that 4.4% of participants were HBsAg positive, a sign of active infection, while 2.9% were anti-HCV positive, indicating exposure to the virus. HBV positivity was more common among men (91%) and individuals of non-Italian origin, mainly from areas with low vaccination coverage. HCV-positive participants included a higher proportion of Italian citizens (51.9%) with a history of extreme marginalisation, often related to past intravenous drug use. Screening was carried out directly at the reception facilities, using rapid tests on capillary blood with results available within minutes. This strategy ensured a high adherence rate of 82%. In addition, the presence of cultural mediators and collaboration with community workers facilitated the referral of positive cases to local clinical centres where 66.3% of HBV-positive and 37.8% of HCV-positive patients were monitored and treated according to clinical assessment. Among patients with active HCV infection, all those treated with antiviral drugs were cured.
“HBV and HCV infections can develop into serious diseases such as cirrhosis and liver cancer, and many people are unaware of their condition until it is at an advanced stage,” explains Dr Laura Gragnani. “This delay in diagnosis is evident in marginalised communities that are not reached by national and regional prevention and screening programmes and who often face barriers in accessing health services, such as lack of information, trust, or financial resources. The results of our study highlight the importance of targeted screening strategies to reduce health inequalities, limit the circulation of these viruses in the community, and achieve the WHO goal of eliminating viral hepatitis as an infectious threat by 2030”. “This research,” adds Monica Monti, “has also highlighted the importance of ‘catching’ and treating marginalised people who often do not have access to official healthcare channels.”
Professor Gabriella Cavallini and Dr Maria Laura Manca from the University of Pisa and Professor Anna Linda Zignego, a retired professor from the University of Florence and director of the MaSVE Centre until October 2023, were also involved in the study.