Model intervention program

“Prevention of Hepatitis C in general practice”

Pontonnaja village is a relatively isolated community officially part of the Kolpino district of St.Petersburg. Pontonnaja was a place where in 1998 local health care personnel together with the faculty of the Department of Family Medicine started community-wide screening and, later, intervention for decreasing CVD morbidity and mortality through reduction of cardiovascular risk factors. The important component in this project was active participation of the local general practitioners (general practice in Pontonnaja has been formed as a part of the project). 

During the project active collaboration between health care personnel, local administration, Kolpino district health administration and community has been formed. As it usually the case in Russian polyclinic health care most attention during first project was given to older segment of the population.

The chief physician of the Pontonnaja policlinic, who also organized family medicine office there has been trained at the School of Public Health at MAPS and so she promptly saw drawback in demand-driven community health care, as it seemed to overlook younger population, more active, less inclined to contact with health care. It became even clearer after analyzing data on blood-transmissible infections and hepatitis in the first place. Morbidity rate for hepatitis B and C combined in 2002 reached 326 per 100,000 population aged 20-29. Number of chronic hepatitis B cases is steadily increasing, from 63.9 per 100,000 in 2000 to 90.4 per 100,000 in 2002. There are several causes of this increase, most important among them being intravenous drug use, promiscuity and - sadly - nosocomial sources.

There is already agreement among community leaders and health care that epidemics of blood-transmissible infections, especially vaccine preventable, if not contained, could pose serious threat to health care in Pontonnaja and could strain already limited health care resources. This corresponds to the COPC approach - blood transmissible infections are important problem in the community (community diagnosis). The intervention is possible and should include education and training campaign, as well as vaccination against hepatitis B. Community is showing its willingness to participate by providing means for purchasing hepatitis B vaccine (obligatory medical insurance funds are not providing means for this).

1. The work started with analysis of prevalence of HCV in  Kolpino district of St.Petersburg and Pontonnaja village. In the structure of HCV the most significant is number is the number the HCV carriers. The highest number of HCV carriers was found to be in 15 – 29 age group.

Table. Active HCV and HCV carriers in Kolpino district by age group per 100 000, 2000 – 2003.

 

  2000

  2001

  2002

  2003

Age grope

HCV carriers

Active HCV

HCV carriers

Active HCV

HCV carriers

Active HCV

HCV carriers

Active HCV

0 – 5 Mon.

2370

-

1383,0

-

5735,2

-

9559

-

5 – 12 Mon.

190

-

383,8

-

610

-

1523

-

1 y

90

-

 

-

-

-

97,6

-

2 y

-

-

 

-

-

-

95,6

-

Subtotal 0 –2 y

420

-

272,1

-

1263

-

2261

-

3 – 6 y

120

-

19,1

-

-

-

-

-

7 – 10 y

-

-

-

-

-

-

-

-

11 – 14 y

-

80

17,2

-

27,4

-

13,7

27,4

Total children

54

0,6

43,2

 -

183

-

317,2

8,1

15 – 19 y

300

120

228,5

155,4

140

44

159,8

51,9

20 – 29 y

130

90

130,7

87,1

476

117

585,8

226,9

30 – 39 y

9

20

106,8

47,5

128

75

222

52,6

40 – 49 y

40

10

39,2

31,4

66,9

63

137,7

31,4

50 – 59 y

20

3

11,9

11,8

48,6

18,2

54,6

54,6

 60 +

10

5

40

10

35,3

12,8

25,6

16,0

Total adults

90

40

86,3

53,1

154,6

56,6

204,7

73,0

Overall

30

40

79,7

44,8

158,7

48,7

220,3

64,0

The highest indicators of HCV carriers are in the age group 15 – 19 (159,8 per 100000) and 20 – 29 (585,9 per 100000). There is an increase in number of HCV carriers among 11-14 years old and they also form natural target for prevention as highest HCV incidence is seen among next age group. Therefore, as a target group will be population 11 – 29 years old will be selected.