Browsing by Author "Baptista-Leite, Ricardo"
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- Beyond viral suppression of HIV - the new quality of life frontierPublication . Lazarus, Jeffrey V.; Safreed-Harmon, Kelly; Barton, Simon E.; Costagliola, Dominique; Dedes, Nikos; Valero, Julia del Amo; Gatell, Jose M.; Baptista-Leite, Ricardo; Mendão, Luís; Porter, Kholoud; Vella, Stefano; Rockstroh, Jürgen KurtBackground: In 2016, the World Health Organization (WHO) adopted a new Global Health Sector Strategy on HIV for 2016-2021. It establishes 15 ambitious targets, including the '90-90-90' target calling on health systems to reduce under-diagnosis of HIV, treat a greater number of those diagnosed, and ensure that those being treated achieve viral suppression. Discussion: The WHO strategy calls for person-centered chronic care for people living with HIV (PLHIV), implicitly acknowledging that viral suppression is not the ultimate goal of treatment. However, it stops short of providing an explicit target for health-related quality of life. It thus fails to take into account the needs of PLHIV who have achieved viral suppression but still must contend with other intense challenges such as serious non-communicable diseases, depression, anxiety, financial stress, and experiences of or apprehension about HIV-related discrimination. We propose adding a 'fourth 90' to the testing and treatment target: ensure that 90 % of people with viral load suppression have good health-related quality of life. The new target would expand the continuum-of-services paradigm beyond the existing endpoint of viral suppression. Good health-related quality of life for PLHIV entails attention to two domains: comorbidities and self-perceived quality of life. Conclusions: Health systems everywhere need to become more integrated and more people-centered to successfully meet the needs of virally suppressed PLHIV. By doing so, these systems can better meet the needs of all of their constituents - regardless of HIV status - in an era when many populations worldwide are living much longer with multiple comorbidities.
- Biologicals and biosimilars: gaps in the pharmacovigilance system in PortugalPublication . Portela, Edit Maria da Conceição Constantino; Sinogas, Carlos; Almeida, Fernando Albuquerque de; Baptista-Leite, Ricardo; Castro-Caldas, AlexandreIntroduction: Biological and biosimilar medicinal products have specific characteristics that call for a closer monitoring of their safety profile. Since the current legal framework stems from both European and national regulations, some gaps in the operational field may be expected. The goal of this paper is to identify these gaps and propose changes to the current information systems and pharmacovigilance regulations. Material and Methods: A qualitative analysis of current pharmacovigilance regulatory framework and supporting information system was conducted. Results: Current pharmacovigilance system does not seem to vouch for the safe use of biologicals and biosimilar drugs. The gaps found in reviewed materials may be attributable to their lack of specificity for biopharmaceuticals. Discussion: Biologicals therapy presents specific determinants related with the drugs, prescription, and traceability, without replication in any other segment of the pharmaceutical market. They are able to shape their safety profile. Conclusion: The existing pharmacovigilance’s regulatory framework should be adjusted in order to improve the safety related with biopharmaceutical therapy. Some intervention measures are proposed.
- Fighting Hepatitis C in a COVID-19 ecosystem. Public health policies are needed more than everPublication . Lopes, Henrique; Baptista-Leite, Ricardo; Franco, Diogo; Kundurzhiev, Todor; Mateva, Lyudmila; Jelev, Dejan; Simonova, Marieta
- Innovative strategies for the elimination of viral hepatitis at a national level: a country case seriesPublication . Schröeder, Sophia E.; Pedrana, Alisa; Scott, Nick; Wilson, David; Kuschel, Christian; Aufegger, Lisa; Atun, Rifat; Baptista-Leite, Ricardo; Butsashvili, Maia; El-Sayed, Manal; Getahun, Aneley; Hamid, Saeed; Hammad, Radi; Hoen, Ellen ‘t; Hutchinson, Sharon J.; Lazarus, Jeffrey V.; Lesi, Olufunmilayo; Li, Wangsheng; Mohamed, Rosmawati Binti; Olafsson, Sigurdur; Peck, Raquel; Sohn, Annette H.; Sonderup, Mark; Spearman, Catherine W.; Swan, Tracy; Thursz, Mark; Walker, Tim; Hellard, Margaret; Howell, JessicaViral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints.
- Integrating public health policies in the epidemiological modeling of hepatitis C with LEHC tool: application in AustriaPublication . Lopes, Henrique; Baptista-Leite, Ricardo; Franco, Diogo; Pirke, Roxana; Gschwantler, MichaelBackground: Eliminating hepatitis C requires addressing issues other than medicines or therapies. Public health policies focused on the hepatitis C virus (HCV) must be emphasized and worked to know the impacts on its epidemiologic dynamics. This research aims to provide a tool to evaluate and simulate alternatives by redefining policies meeting specific needs in each country towards the HCV elimination target by 2030. Methods: The development of a gamified model with 24 public health policies focused on HCV was conducted to evaluate the impact of measures in the disease epidemiologic dynamics. The Let’s End HepC (LEHC) project encompassed key populations (people who inject drugs [PWID], prisoners, blood products and remnant population) in Austria and other countries, presenting prospects for every year from 2019 to 2030. The LEHC epidemiological model comprised an integrated solution for HCV, with adaptive conjoint analysis (ACA) and Markov chains constituting its main processes. Results: Despite Austria’s efforts towards achieving the HCV elimination goal by 2030, the LEHC model forecast quantitative analysis predicts that it is still not enough to meet the target; however, prospects are very optimistic if public health policies are adapted to the country’s needs, being possible to achieve the goal as early as 2026. Conclusion: In Austria, the LEHC tool allowed to forecast the HCV elimination year anticipation to 2026, instead of being achieved after 2030. This target will only be valid if adequate management of the 24 public health policies focused on this pathology is further implemented.
- Let's End HepC: modelling public health epidemiological policies applied to Hepatitis C in SpainPublication . Lopes, Henrique; Baptista-Leite, Ricardo; Franco, Diogo; Serra, Miguel A.; Escudero, Amparo; Martín-Moreno, José M.Background: The WHO has defined international targets toward the elimination of hepatitis C by 2030. Most countries cannot be on track to achieve this goal unless many challenges are surpassed. The Let's End HepC (LEHC) tool aims to contribute to the control of hepatitis C. The innovation of this tool combines the modelling of public health policies (PHP) focused on hepatitis C with epidemiological modelling of the disease, obtaining a unique result that allows to forecast the impact of policy outcomes. The model was applied to several countries, including Spain. Methods: To address the stated objective, we applied the “Adaptive Conjoint Analysis” for PHP decision-making and Markov Chains in the LEHC modelling tool. The tool also aims to be used as an element of health literacy for patient advocacy through gamification mechanisms and country comparability. The LEHC project has been conducted in several countries, including Spain. The population segments comprised in the project are: People Who Inject Drugs (PWID), prisoners, blood products, remnant population. Results: A total of 24 PHP related to hepatitis C were included in the LEHC project. It was identified that Spain had fully implemented 14 of those policies to control hepatitis C. According to LEHC's model forecast, the WHO's Hepatitis C elimination goal on reducing the number of patients living with Hepatitis C to 10% can be achieved in Spain by 2026 if current policies are maintained. The model estimates that the total population in Spain, by 2026, is expected to comprise 26,367 individuals living with hepatitis C. Moreover, if the 24 PHP considered for this study are fully implemented in Spain, the elimination goal may be achieved in 2024, with 29,615 individuals living with hepatitis C by that year. Conclusion: The findings corroborate the view that Spain has set great efforts in directing PHP toward Hepatitis C Virus (HCV) elimination by 2030. However, there is still room for improvement, namely in further implementing 10 of the 24 PHP considered for the LEHC project. By maintaining the 14 PHP in force, the LEHC model estimates the HCV elimination in the country by 2026, and by 2024 if further measures are employed to control the disease.
- Modeling the puzzle of hepatitis C epidemiology in Romania: a pathway to controlPublication . Lopes, Henrique; Baptista-Leite, Ricardo; Franco, Diogo; Eclemea, Irina; Bratu, Eugenia C.; Furtunescu, Florentina L.; Pop, Corina Silvia; Pana, Bogdan C.Background & Aims: To combat hepatitis C virus (HCV) and achieve its elimination by 2030, the emphasis should be on public health policies. In this study, we investigated the dynamics of epidemiology of HCV in Romanian risk groups that are characterized by higher occurrence densities with the aid of The Let’s End HepC (LEHC) project. Methods: The LEHC project addressed the modelling of HCV epidemiology, being applied in several countries, one of which is Romania. The model comprised an integrated solution of public health policies focused on the disease, using Adaptive Conjoint Analysis and Markov chains systems. This tool allowed the quantitative evaluation of public health policies‘ impact, for every year until 2030, in five population groups: people who inject drugs (PWID), prisoners, individuals who have received blood products, children at risk for vertical transmission, and the remnant population. Results: It appears that Romania was already making great efforts in the context of public policies, allowing the achievement of HCV elimination by 2028 if current policies were maintained. Through additional work and greater efforts in further implementing public policies, the LEHC model estimated the possibility of anticipating this outcome to 2026. Conclusion: The LEHC model estimated an anticipation of the HCV elimination year in Romania to be 2026 if the twenty-four health policies in the study are fully implemented and consistently maintained over the years.
- A multinational Delphi consensus to end the COVID-19 public health threatPublication . COVID-19 Consensus Statement Panel; Lazarus, Jeffrey V.; Romero, Diana; Kopka, Christopher J.; Karim, Salim Abdool; Abu-Raddad, Laith J.; Almeida, Gisele; Baptista-Leite, Ricardo; Barocas, Joshua A.; Barreto, Mauricio L.; Bar-Yam, Yaneer; Bassat, Quique; Batista, Carolina; Bazilian, Morgan; Chiou, Shu Ti; Del Rio, Carlos; Dore, Gregory J.; Gao, George F.; Gostin, Lawrence O.; Hellard, Margaret; Jimenez, Jose L.; Kang, Gagandeep; Lee, Nancy; Matičič, Mojca; McKee, Martin; Nsanzimana, Sabin; Oliu-Barton, Miquel; Pradelski, Bary; Pyzik, Oksana; Rabin, Kenneth; Raina, Sunil; Rashid, Sabina Faiz; Rathe, Magdalena; Saenz, Rocio; Singh, Sudhvir; Trock-Hempler, Malene; Villapol, Sonia; Yap, Peiling; Binagwaho, Agnes; Kamarulzaman, Adeeba; El-Mohandes, AymanDespite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.
- Securing wider EU commitment to the elimination of hepatitis C virusPublication . Wedemeyer, Heiner; Tergast, Tammo L.; Lazarus, Jeffrey V.; Razavi, Homie; Bakoyannis, Kostas; Baptista-Leite, Ricardo; Bartoli, Marco; Bruggmann, Philip; Buşoi, Cristian Silviu; Buti, Maria; Carballo, Manuel; Castera, Laurent; Colombo, Massimo; Coutinho, Rodrigo Sousa; Dadon, Yuval; Esmat, Gamal; Esteban, Rafael; Farran, Joan Colom; Gillyon-Powell, Mark; Goldberg, David; Hutchinson, Sharon; Janssen, Harry L.A.; Kalamitsis, George; Kondili, Loreta A.; Lambert, John S.; Marinho, Rui Tato; Maticic, Mojca; Patricello, Aldo; Peck-Radosavljevic, Markus; Pol, Stanislas; Poljak, Mario; Pop, Cora; Sokol, Tomislov; Sypsa, Vana; Tözün, Nurdan; Younossi, Zobair; Aghemo, Alessio; Papatheodoridis, George V.; Hatzakis, AngelosIn 2016, the Hepatitis B and C Public Policy Association (HepBCPPA), gathered all the main stakeholders in the field of hepatitis C virus (HCV) to launch the now landmark HCV Elimination Manifesto, calling for the elimination of HCV in the EU by 2030. Since then, many European countries have made progress towards HCV elimination. Multiple programmes—from the municipality level to the EU level—were launched, resulting in an overall decrease in viremic HCV infections and liver-related mortality. However, as of 2021, most countries are not on track to reach the 2030 HCV elimination targets set by the WHO. Moreover, the COVID-19 pandemic has resulted in a decrease in HCV diagnoses and fewer direct-acting antiviral treatment initiations in 2020. Diagnostic and therapeutic tools to easily diagnose and treat chronic HCV infection are now well established. Treating all patients with chronic HCV infection is more cost-saving than treating and caring for patients with liver-related complications, decompensated cirrhosis or hepatocellular carcinoma. It is more important than ever to reinforce and scale-up action towards HCV elimination. Yet, efforts urgently need the dedicated commitment of policymakers at all governmental and policy levels. Therefore, the third EU Policy Summit, held in March 2021, featured EU parliamentarians and other key decision makers to promote dialogue and take strides towards securing wider EU commitment to advance and achieve HCV elimination by 2030. We have summarized the key action points and reported the ‘Call-to-Action’ statement supported by all the major relevant European associations in the field.
- The road towards the responsible and safe legalization of cannabis use in PortugalPublication . Baptista-Leite, Ricardo; Ploeg, LisaIntroduction: Recently, the world has seen examples of the legalization of cannabis for recreational purposes. Due to the diversity of experiences in progress, it is urgent to analyze the impacts of this legalization, from a public health perspective. Therefore, this article aims to review the accumulated knowledge in the states and countries where the use of cannabis is legal and to ponder over the relevance of starting a similar path towards legalization in Portugal, thus supporting political decisions to be properly informed and evidence-based. Material and Methods: An extensive literature review was performed using databases and scientific journals, such as PubMed, as well as the search of institutional documentation, including the EMCDDA and SICAD. Results: The gathered information provided insights and enabled assessment of (1) the acute and chronic effects of cannabis use on health, (2) the Portuguese situation related to cannabis and (3) the processes and lessons learned after the legalization of cannabis in other countries or states. Given the above, and according to the data presented, the authors argue for a safe and responsible strategy towards the legalization of cannabis use in Portugal. In accordance, a set of concrete proposals are presented. Discussion: From a public health perspective, it is assumed that the interest of this proposal is to reduce the problematic use of cannabis, to effectively fight against illicit drug trafficking and drug-related crime, as well as health promotion and prevention of addictions and other adverse health impacts. This article reveals that the effects of legalization might, contrary to general beliefs, generate positive results with respect to these aims, given that there will be greater control on the market, price, quality, and information - to name a few - if implementation occurs with proper consideration and definition. Conclusion: The debate on the responsible and safe legalization of cannabis use in Portugal should be open and promoted, based on a public health perspective.