Raffaella Bucciardini

Aims: Non-communicable diseases (NCDs), including cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases, are responsible for 74% of deaths worldwide (2019). In Europe, they account for over 91% of deaths and 87% of disability-adjusted life years (DALYs). Mental disorders, also considered NCDs, rank seventh globally in terms of DALYs. These burdens are exacerbated by socioeconomic and educational inequalities that shape the distribution of risk factors and cause preventable disparities in health and mortality. This article presents the new Joint Action on Cancer and other NCDs (JA-PreventNCD), outlining its objectives and methodological strategies to tackle inequalities in Europe. Methods: The JA-PreventNCD started in January 2024. It was launched under the EU4Health Programme for the period of 2021–2027, with a specific focus on social inequalities. Over its four-year span, the initiative will: (1) collect evidence on inequalities in major NCDs and their risk factors; (2) review policies targeting these disparities; (3) provide training based on an equity lens approach; (4) enhance health literacy through multi-level activities. Conclusions: The JA-PreventNCD initiative represents a crucial opportunity to address health inequalities related to NCDs across Europe. Its findings will contribute to evidence-based health policies and promote sustainable strategies aimed at closing the gaps. Enhanced collaboration among European countries and the exchange of best practices will foster informed policy-making, leading to long-term improvements in public health .

Aims: Health literacy is considered a key social determinant of health. It plays an important role in the prevention and management of non-communicable diseases (NCDs), contributing to better health and well-being. Therefore, the overall aim of the health literacy focus (Action) within the European Joint Action to prevent NCDs (JA PreventNCD) is to promote general, digital, mental and organizational health literacy to improve health outcomes and counteract NCD-related health inequities in Europe. This paper presents a rational and methodological approach for strengthening health literacy in Europe. Methods: The Action will be implemented through collaboration among 13 EU Member States and three non-EU Member States, using both quantitative and qualitative research approaches including questionnaire-based surveys, literature reviews, in-depth interviews, and focus groups, as well as stakeholder and user involvement. The implementation will be guided by a Health Literacy Approach to Theory of Change and carried out in three main phases: 1) project development, 2) data collection, data-analysis and tool development, and 3) recommendations for policy, research, and practice and dissemination. Conclusions: The project supports participating countries in conducting a comprehensive national-level situation analysis and provides a solid foundation for further developing national health literacy-related policies, strategies or action plans. The project’s expected outcome will contribute to promoting general, digital, mental and organizational health literacy in the prevention of NCDs in Europe. A Theory of Change and a coordinated approach facilitate the development of shared platforms, such as the European Health Literacy Arena, which help maintain collaboration and visibility beyond the lifetime of the project.

Health inequalities are determined only in part by the health system; most are caused by the actions of non-health sectors or their policies, such as education, employment, environment, agriculture, or immigration, among others. People’s health and well-being are determined by the circumstances and conditions of their daily life, which are, in turn, influenced by factors […]

Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country’s adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.

Health protection and health promotion still represent a major challenge for policymakers across the world. The outbreak of the COVID-19 pandemic has further highlighted the structural weaknesses already existing within and between countries, which, depending on the country, may concern the fragility of health systems, the vulnerability of economic systems, or the fragility of the […]

Introduction Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed. Methods We used data from the ‘Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan–Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition. Results A total of 1198 patients were included in the study. Kaplan–Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count Conclusions The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (lSS-HIV symptoms scale). The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results.

Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia. We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation. The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77–3.23). Active TB (HR 1.72, 95% CI: 1.23–2.41) and gender (HR 1.64, 95% CI: 1.10–2.56) were also significantly associated with attrition. Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of different sex to improve retention in care in male population.

Background: Health-related quality of life (HRQoL) has been recognized as a central measure of the overall health status in HIV patients. With the availability of different highly effective drug combinations, maximizing quality-adjusted survival has become a major target of HIV treatment. Although the association of HIV RNA and CD4 cell count with clinical HIV progression has been well established, the relation between these markers and HRQoL measures is still unclear. Method: This cross-sectional study investigated the relationship linking HIV RNA and CD4 to HRQoL measures in 181 triple-class-experienced patients with advanced HIV disease. The instrument used was the ISSQoL, a self-administered and HIV-specific HRQoL questionnaire. Results: Data showed no correlation between HRQoL measures and CD4 counts. Higher HIV RNA levels were, however, associated with poor HRQoL scores in 3 out of 9 scales of social functioning, depression and anxiety, and satisfaction with quality of life. In multivariable analyses, only the satisfaction with quality of life mean score remained significantly lower for the HIV RNA >100,000 copies/mL group compared to the HIV RNA 50 to 10,000 copies/mL group. Conclusions: Although other determinants of HRQoL in people with HIV should also be considered, this finding suggests a negative impact of high viral load on perceived HRQoL that adds to other described determinants of lower quality of life in people with HIV, such as lower social support and self-reported symptoms.