Bridging the gap: Addressing disparities in hepatitis C screening, access to care, and treatment outcomes

Hepatitis C virus(HCV)is a significant public health challenge globally,with substantial morbidity and mortality due to chronic liver disease.Despite the availability of highly effective and well-tolerated direct-acting antiviral therapies,widespread disparities remain in hepatitis C screening,access to treatment,linkage to care,and therapeutic outcomes.This review article synthesizes evi-dence from various studies to highlight the multifactorial nature of these dispari-ties,which affects ethnic minorities,people with lower socioeconomic status,in-dividuals with substance use disorders,and those within correctional facilities.The review also discusses policy implications and targeted strategies needed to overcome barriers and ensure equitable care for all individuals with HCV.Recom-mendations for future research to address gaps in knowledge and evaluation of the effectiveness of interventions designed to reduce disparities are provided.

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients:People of diverse ethnic background and color,children with disabilities,sexual and gender minorities,pregnant women,mature adults,and those patients living in urban and rural communities.The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression,anxiety and posttraumatic stress disorder symptoms.Those psychiatric patients who are ethnic minorities display barriers to care,including collective trauma and structural racism.Sexual and gender minorities with mental illness face discrimination and limited access to treatment.Pregnant women with psychiatric diagnoses show higher exposure to domestic violence.Children with disabilities face a higher risk of worsening behavior.Mature adults with psychiatric problems show depression due to social isolation.Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities,which face limited access to telehealth services.We suggest that social programs that decrease discrimination,enhance communal resilience,and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Evaluating the implementation of rapid diagnostic tests in a malaria elimination setting

Background It was recommended that malaria rapid diagnostic tests(RDTs)should be available in all epidemiological situations.But evidence was limited on the implementation of RDTs and its effectiveness in malaria elimination settings.This study examined the implementation of RDTs and how it affected the diagnosis of imported malaria patients in Jiangsu Province,China.Methods To scale up RDTs,this study developed an intervention package with four major elements covering the supply of RDT test,the training on RDTs,the monitoring and management of RDT use,and the advocacy of RDTs.By using a pretest-posttest control group design,we implemented the interventions in 4 cities in Jiangsu Province with the rest nine cities as controlled areas,from January 2017 to January 2018.Difference-in-Difference approach was used to evaluate the impact of the scale-up of RDTs on the identification of malaria cases.Three binary outcome measures were included to indicate delayed malaria diagnosis,malaria cases with confirmed malaria diagnosis at township-level institutions,and severe malaria cases,respectively.Linear probability regression was performed with time and group fixed effects and the interaction term between time and group.Results Intervention areas received sufficient RDT test supply,regular professional training programs,monthly tracking and management of RDT supply and use,and health education to targeted population.The implementation of interventions was associated with 10.8%(P=0.021)fewer patients with delayed diagnosis.But intervention areas did not see a higher likelihood of having confirmed diagnosis from township-level institutions(coefficient=-0.038,P=0.185)or reduced severe malaria cases(coef.=0.040,P=0.592).Conclusions The comprehensive package of RDT implementation in this study is promising in scaling up RDT use and improving access to care among malaria patients,especially in malaria elimination settings.

Equity and seeking treatment for young children with fever in Nigeria: a cross-sectional study in Cross River and Bauchi States

Background:Poor children have a higher risk of contracting malaria and may be less likely to receive effective treatment.Malaria is an important cause of morbidity and mortality in Nigerian children and many cases of childhood fever are due to malaria.This study examined socioeconomic factors related to taking children with fever for treatment in formal health facilities.Methods:A household survey conducted in Bauchi and Cross River states of Nigeria asked parents where they sought treatment for their children aged 0–47 months with severe fever in the last month and collected information about household socio-economic status.Fieldworkers also recorded whether there was a health facility in the community.We used treatment of severe fever in a health facility to indicate likely effective treatment for malaria.Multivariate analysis in each state examined associations with treatment of childhood fever in a health facility.Results:43%weighted(%wt)of 10,862 children had severe fever in the last month in Cross River,and 45%wt of 11,053 children in Bauchi.Of these,less than half(31%wt Cross River,44%wt Bauchi)were taken to a formal health facility for treatment.Children were more likely to be taken to a health facility if there was one in the community(OR 2.31[95%CI 1.57–3.39]in Cross River,OR 1.33[95%CI 1.0–1.7]in Bauchi).Children with fever lasting less than five days were less likely to be taken for treatment than those with more prolonged fever,regardless of whether there was such a facility in their community.Educated mothers were more likely to take children with fever to a formal health facility.In communities with a health facility in Cross River,children from less-poor households were more likely to go to the facility(OR 1.30;95%CI 1.07-1.58).Conclusion:There is inequity of access to effective malaria treatment for children with fever in the two states,even when there is a formal health facility in the community.Understanding the details of inequity of access in the two states could help the state governments to plan interventions to increase access equitably.Increasing geographic access to health facilities is needed but will not be enough.