Mobile clinic and InfoHep Centre
Summary and objectives
In Croatia liver disease is one of the top 10 causes of mortality responsible for 44 % of all deaths in Croatia in 2019, which is above the EU average.
The prevalence of hepatitis infection in Croatia is estimated at 0.6% or approximately 26.000 people for HCV and 1% or approximately 43.600 people for HBV at risk of liver cirrhosis, HCC and liver failure.
The marginalized population is even more affected by these issues since, despite the growing number of patients, stigma still equates liver disease with socially unacceptable high-risk activities, resulting in restricted information flow, number of patients reluctant to contact a doctor, leading to the development of stigma and prejudice, especially towards vulnerable (at risk) groups, not only by the general public but by health care workers as well.
Croatian Society for the Liver Diseases „Hepatos" is providing information about the problems faced by patients with liver disease, especially vulnerable groups, the prevalence of the disease, types of prejudice and stigma affecting patients and most importantly, as part of linkage to care service, in cooperation with the long term partnering teams of specialists, is offering mobile clinic - medical vehicle services directly in the marginalized communities.
Aiming to provide equality of care by speeding up testing, treatment and care to key populations and people facing barriers in access to health coverage, be it geographically or due to stigmatization, (people living on islands, in rural communities or recovering from substance use disorder, people in prisons and closed settings, homeless people, war veterans…), …), in order to provide wider access to safe and effective prevention services and linkage to care, Hepatos publicly offers in community specialized services provided by hepatologists from local hospitals based on screening by local epidemiologists or GP’s.
Over the past decade it has, slowly but steadily, made inroads in liver health awareness by developing opportunistic programs for early detection of liver disease, making it a guarantee of the best care.
Most recognized is the Mobile InfoHep Center (MIHC), a mobile clinic i.e. medical vehicle fully equipped with state-of-the-art health services offered by an expert team. This best example of good practice unites local public health experts, local physicians and specialists and civil society volunteers who tailor each activity to the different audiences in order to build trust and best serve each individual marginalized community.
Besides carrying out awareness raising activities, the unit provides testing services, pre and post-test counselling, liver elastography and a physician assigned as a point of contact to link diagnosed patients to appropriate treatment and care.
The team also provides peer monitoring, counseling, and awareness raising education.
During the last 9 years (inc. COVID 19 limited access since 2020) over 200 activities in 8 countries (besides Croatia we have organized activities in Albania, Austria, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia), and 66 cities were organized during which over 4000 persons benefited from person centered linkage to care i.e."wrap around services“ offered.
The model is innovative and has brought together governmental institutions, private sector and civil society while delivering equity and access to health, and fight against stigma and discrimination.
Inter-sectorial collaboration, joint action and teamwork have proven to be excellent and successful public health tools to raise awareness and educate people and health-care professionals.
After the implementation of MIHC, both the number of newly diagnosed HCV infections in Split-Dalmatia County and hepatitis C treatments in Croatia increased, with the proportion of treatments in County leaping from 16.5% in 2014 to 48.80% in 2018 and keeping steady since.
During 2021, more than 90% of HCV-treated persons in Split–Dalmatia County were linked to care through the MIHC activities and/or used the services „Hepatos” which provides in order to get timely access to health care.
Significant increase in case finding and proportion of treatments for Split-Dalmatia County displays the success of good practice and enable MIHC to promote and implement activities allover Croatia and neighboring countries.