Dissertation committee:
Παπαθεοδωρίδης Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μανωλακόπουλος Σπήλιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τουλούμη Παναγιώτα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Καντζανού Μαρία, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σύψα Βασιλική-Αναστασία, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Παρασκευής Δημήτρης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ντόιτς Μαρία-Μέλανη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background: Viral hepatitis B (HBV) and C (HCV) and HIV infection are among the most important public health problems. The World Health Organization (WHO) and UNAIDS have set a goal of eliminating hepatitis B and C and control HIV infection by 2030. In Greece, although several studies have been conducted for all three diseases, most of them concerned specific population groups. The aim of this PhD was a) to assess the prevalence and the cascade of care of the three infectious diseases in the general population of Greece, b) to identify the factors associated with history of previous testing as well of positive results, c) to assess the knowledge level and attitude against these three infections and to identify factors associated with the level of knowledge.
Methods: Data were derived from the Hprolipsis, the first Health Examination Survey of HBV, HCV and HIV in a random sample of adults living in Greece that conducted during May 2013 and June 2016. The study sample consists of 5,993 adults (≥18 years). A multistage stratified random sampling method based on 2011 Census was applied to collect the sample. For the statistical evaluation, statistical methods that take into account the study sampling design were used with additional weighting to match the age/sex and geographical area distribution of sample to that of the general population. Multiple imputation method was used for missing values. All statistical analyses were performed using the statistical software STATA (version 13.0).
Results: Of the 5993 participants 2546 were men (48.5%) and the mean age (IQR) was 47.7 (34-64) years. 4246 of the participants had also a blood test results. The estimated prevalence (95% CI) of HBV and HCV was relatively low at 1.7% (1.3, 2.3) and 0.9% (0.6, 1.3) respectively, and for HIV was very low at 0.08% (0.02, 0.3). The undiagnosed fraction for the three infectious diseases was 67.0% (HBV), 69.3% (HCV), and 50% (HIV) whereas of those who were diagnosed a significant percentage had never been treated (80.7% for hepatitis B and 60.2% for hepatitis C).
Concerning knowledge level our results showed that there are significant knowledge gaps with overall knowledge level being low to a significant percentage of the participants (27.9%, 33.1%, and 29.1% for HBV, HCV, and HIV, respectively), finding that it is mainly attributed to the high levels of misconception about transmission modes (65.9% for hepatitis B, 67.2% for hepatitis C and 67.9% for HIV). Women, higher monthly family income, higher educational level, Greek origin (born in Greece or Cyprus), residence in the two big urban centers (Athens /Thessaloniki), been tested for at least one of the three infectious diseases and high medical risk were statistically significant associated with a higher level of knowledge whereas older age was associated with lower level of knowledge.
One out of three individuals of the general adult population in Greece (34%) had ever been screened for at least one of the three infectious diseases with this percentage varied by infection (30.9%for hepatitis B, 22.8% for hepatitis C and 20% for HIV infection). The age group 30-39 years is screened more often (53.5%). Women who have children are tested more often than women who do not (p-value <0.001). The higher level of education, the higher level of knowledge about infectious diseases as well as high behavioral and medical risk were statistically significant associated with a higher probability of being tested in the past for at least one disease. Moreover, vaccinated individuals were, in general, more likely to have been tested, with the difference increasing at older ages.
Finally, from the multivariable analysis of factors associated with positive virological test results for hepatitis B and C, it was found that male and country of birth in Balkan are statistically significant associated with higher odds of having positive Australian antigen and anti-HBc antibodies, while higher educational level, higher family income and condom use are associated with a lower probability of having positive Australian antigen and anti-HBc. A family history of hepatitis was associated with a statistically significant higher odd of having a positive Australian antigen (OR = 4.56, p-value <0.001). As older the age, as higher the odds of having positive anti-HBc (p-value <0.001), and as lower the odds of having a positive Australian antigen. For hepatitis C as older the age as higher the odds of being anti-HCV positive whereas intravenous drug use and being single/without a partner were associated with being anti-HCV positive.
Conclusions: For first time in Greece the prevalence of HCV, HBV and HIV, the knowledge level and the testing history compared with virological blood results and their association with risk factors were assessed in a random sample of the general population. The prevalence of HCV, HBV and HIV was relatively low. Only one out of three individuals had been tested in the past for at least one of the three infectious diseases. It was also, found that there are significant knowledge gaps in the Greek general population regarding modes of transmission and preventive measures. The results of this work provide the needed data to help the design of targeted public health policies in order to achieve the WHO goal of hepatitis elimination by 2030, highlight the necessity for large scale awareness activities to fill in the gap of knowledge and demonstrate the importance and necessity of developing and implementing information actions of the general population for promoting the screening and early diagnosis of HBV, HCV and HIV in Greece.
Keywords:
HBV, HCV, HIV, Prevalence, Knowledge, Testing history
