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Background: Limited data exists about treatment outcomes in nationwide hepatitis C virus (HCV) elimination programs where injection drug use (IDU) is the main mode of transmission. In 2016 Iceland initiated the HCV elimination program known as Treatment as Prevention for Hepatitis C (TraP HepC). Factors associated with HCV cure in this population are examined., Methods: Unrestricted access was offered to direct acting antiviral agents (DAAs). Testing and harm reduction was scaled up and re-treatments were offered for those who did not attain cure. Cure rates for the first 36 months were assessed and factors associated with failure to achieve cure analysed using multivariable logistic regression., Results: Treatment was initiated for 718; 705 consented for the study. Median age was 44 years (IQR 35-56), history of IDU reported by 593 (84.1 %), recent IDU by 234 (33.2 %); 48 (6.8 %) were homeless. Of 705 patients, 635 achieved cure (90.1 %) during the first treatment. A total of 70 (9.9 %) patients initiated two or more treatments, resulting in 673 participants cured (95.5 %). By multivariable analysis, homelessness was the only statistically significant independent factor associated with not achieving cure (OR 2.67, 95 % CI 1.32-5.41) after first treatment attempt., Conclusion: By reengagement in care and prompt retreatment when needed, a cure rate of 95.5 % was achieved. Unstable housing, a potentially actionable factor is associated with poor outcome., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SO, MG, RHF, and VR report consultancy and speaker's fees from Gilead Sciences. MHel's institute receives funding from Gilead Sciences and AbbVie for investigator-initiated research on which MHel is a chief investigator. All other authors declare no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

Background: WHO has set targets to eliminate hepatitis C virus (HCV) infection as a global health threat by 2030 through a 65% reduction in HCV-related deaths and 80% reduction in HCV incidence. To achieve these goals, WHO set service coverage targets of 90% of the infected population being diagnosed and 80% of eligible patients being treated. In February, 2016, Iceland initiated a nationwide HCV elimination programme known as treatment as prevention for hepatitis C (TraP HepC), which aimed to maximise diagnosis and treatment access. This analysis reports on the HCV cascade of care in the first 3 years of the programme., Methods: This population-based study was done between Feb 10, 2016, and Feb 10, 2019. Participants aged 18 years or older with permanent residence in Iceland and PCR-confirmed HCV were offered direct-acting antiviral (DAA) therapy. The programme used a multidisciplinary team approach in which people who inject drugs were prioritised. Nationwide awareness campaigns, improved access to testing, and harm reduction services were scaled up simultaneously. The number of infected people in the national HCV registry was used in combination with multiple other data sources, including screening of low-risk groups and high-risk groups, to estimate the total number of HCV infections. The number of people diagnosed, linked to care, initiated on treatment, and cured were recorded during the study. This study is registered with ClinicalTrials.gov, NCT02647879., Findings: In February, 2016, at the onset of the programme, 760 (95% CI 690-851) individuals were estimated to have HCV infection, with 75 (95% CI 6-166) individuals undiagnosed. 682 individuals were confirmed to be HCV PCR positive. Over the next 3 years, 183 new infections (including 42 reinfections) were diagnosed, for a total of 865 infections in 823 individuals. It was estimated that more than 90% of all domestic HCV infections had been diagnosed as early as January, 2017. During the 3 years, 824 (95·3%) of diagnosed infections were linked to care, and treatment was initiated for 795 (96·5%) of infections linked to care. Cure was achieved for 717 (90·2%) of 795 infections., Interpretation: By using a multidisciplinary public health approach, involving tight integration with addiction treatment services, the core service coverage targets for 2030 set by WHO have been reached. These achievements position Iceland to be among the first nations to subsequently achieve the WHO goal of eliminating HCV as a public health threat., Funding: The Icelandic Government and Gilead Sciences., Competing Interests: Declaration of interests SO, MG, RHF, and VR report consultancy and speaker's fees from Gilead Sciences. MHel's institute receives funding from Gilead Sciences and AbbVie for investigator-initiated research on which MHEl is a chief investigator. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct-acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale-up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879., (© 2018 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Introduction: An estimated 50-75% of visits to cardiac emergency departments are due to chest pain which is non-cardiac in nature (non-cardiac chest pain (NCCP). This study evaluates the prevalence of NCCP in the emergency departments at Landspitali, and assesses its association with continued chest-pain post discharge, mental well--being and the information-provision provided to NCCP patients during hospitalization., Material and Methods: Participants were 390 patients (18-65 years) presenting with chest pain to the cardiac emergency or the general emergency department at Landspitali from October 2015-May 2016. Measurements included questionnaires assessing somatic symptoms, mental well-being and quality of life, and questions regarding continued chest-pain and information-provision during hospitalization., Results: In total 72% of participants (282) were considered having NCCP while 24% (92) had cardiac disease. NCCP patients experienced a similar burden of somatic and depressive symptoms, but slightly more anxiety and mental distress than cardiac patients. Equal proportions (60%) of NCCP and cardiac patients reported having experienced chestpain post discharge. Continued chest-pain was, however, associated with greater anxiety (β=0.18, p<0.001) and depression (β=0.18, p<0.003) among NCCP patients. Thirty percent of NCCP patients lacked instructions of how to respond to continued chest-pain and only 40% received information regarding other possible causes of chest pain., Conclusion: NCCP was prevalent among patients presenting to emergency departments at Landspitali. The majority of NCCP patients experienced continued chest-pain after discharge, and such pain experience was associated with mental distress. A third of NCCP patients lacked information about possible causes for the pain and advice about coping with symptoms.

After histological review of all cases registered during the period 1964-1985 at the Cancer Registry, 260 cases with endometrial carcinoma were eligible for analyses of survival rates and prognostic factors, as well as the association of Pap-smear screening attendance with these factors and survival. The total age-adjusted 5- and 10-year relative survival rates were 76% and 75%, respectively. The prognostic factors were tested by univariate analysis and simultaneously by a multivariate analysis using the Cox proportional hazards model. Factors that independently gave a less favorable prognosis were non-attendance at screening, older age at diagnosis, deep myometrial invasion, advancing stages and tumor grading, radiotherapy only, extra-genital symptoms and histology types of serous, clear cell and undifferentiated tumors (histologic type 3). Tested simultaneously with the Cox proportional hazards model, parameters that maintained a less favourable prognosis were grade 3, stage III-IV, deep myometrial invasion, older age, radiotherapy only and extra-genital symptoms. In addition, screening attendance showed significant interaction with age. In stages III and IV only grade 3 maintained a significantly less favorable prognosis. We conclude that our results indicate that attendance at Pap-smear screening (taking Pap smears and screening for genital symptoms) has a favorable prognostic value, especially among women under the age of 62.