Viral hepatitis

Viral hepatitis is a global public health challenge, comparable to other major communicable diseases, including HIV, tuberculosis and malaria. In 2016, the WHO launched the first Global Health Sector Strategy on Viral Hepatitis with the aim of eliminating viral hepatitis as a major public health threat by 2030. In order to achieve this ambitious goal, a rapid and massive scale-up of diagnosis and treatment is required.

Hepatitis C

Hepatitis C virus (HCV) chronic infection is characterised by a slow and silent progression, and it is the leading cause of liver-related morbidity and mortality worldwide due to HCV-related complications, which include: cirrhosis, hepatocellular carcinoma and liver failure. With the advent of highly-effective new antiviral drugs, HCV infection can be currently cured by antiviral treatment in most patients. However, many infected people are unaware of their infection and, therefore, are not eligible for treatment. This is especially relevant among vulnerable populations, such as people who inject drugs or migrants from endemic countries.

The main research activity of this group focuses on the molecular study of HCV and involves aspects of basic oriented, clinical and public health research, which have been developed through overlapping competitive research projects and collaboration agreements with the industry. The group is working towards the elimination of HCV infection in collaboration with the Public Health Agency of Catalonia (within the Plan for the Prevention and Control of Hepatitis C in Catalonia), CEEISCAT and other groups through two main strategies:

• Improvement of the diagnosis of active HCV infection and linkage to care.
  • Design and implementation of new diagnostic assays and screening strategies in community and healthcare settings.
  • Promoting the micro-elimination of HCV in vulnerable populations through new models of care including education, prevention, screening, and linkage to care and treatment, and combating reinfection.
• Characterisation of the molecular epidemiology of HCV: assessment of epidemiological markers (prevalence, incidence, acute infection) and transmission dynamics in key populations by next generation sequencing and phylogenetic analysis to understand how the virus spreads and contribute to its control.

Hepatitis B

Regarding hepatitis B virus (HBV), the group has been working on two main activities in vulnerable populations:

• Design and implementation of new strategies for education, screening, and linkage to care and treatment.
• Assessment of HBV vaccination needs and targeted vaccination strategies.

The team is also working to expand screening of vulnerable populations not only for viral hepatitis, but also for other infectious diseases such as sexually transmitted infections (STI) and tuberculosis, in an integrated and people-centered way.

Molecular diagnostics and genomic epidemiology of other infectious diseases

Over the last five years, this research group has been applying its knowledge in next-generation sequencing and phylogenetic analysis - previously acquired in the field of HCV - to other pathogens with clinical and public health interest. By sequencing the genome of pathogen samples from patients, we can study the origin of outbreaks, how they spread and evolve, and which strategies may contain them. In this way, genomics can guide decisions of infection control teams and public health authorities about how to target their efforts to control transmission. Additionally, whole genome sequencing has become the reference method for typing and studying antimicrobial resistance for a growing number of pathogens. Pathogen genomics is increasingly being used for a new generation of diagnostics and therapeutics.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Following the first pandemic wave of coronavirus disease 2019 (COVID-19), the emergence of SARS-CoV-2 variants has led to waves of infections across the globe. With the COVID-19 pandemic, genomic surveillance has been implemented at scale worldwide for the first time, with an unprecedented rate of genome data generation, greater than for any other pathogen.

• Genomic surveillance of circulating variants, for the early detection of mutations, monitoring of virus evolution and evaluating how variants might hamper detection by diagnostic tests, as well as influence effectiveness of vaccines and antivirals, to ultimately inform public health interventions.
• Genomic epidemiology studies of outbreaks in hospitals, long-term care facilities and other closed settings, in order to characterize virus spread and translate genomic information into meaningful clinical reports for infection control teams in order to improve outbreak control.

The group is also working to expand this line of research to other respiratory viruses, such as influenza virus and respiratory syncytial virus (RSV).

Tuberculosis (TB)

Worldwide, TB is the second leading infectious killer after COVID-19 (above HIV/AIDS). Multidrug-resistant TB (MDR-TB) remains a public health concern and a health security threat. Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals. Despite significant progress in the control of Mycobacterium tuberculosis complex (MTBC) transmission, traditional contact-tracing strategies have limitations that can be overcome using whole genome sequencing (WGS) data as a high-resolution epidemiological marker.

The group led a pioneering prospective, population-based, multicentre study of genomic epidemiology of the MTBC strains circulating in Catalonia, in collaboration with Iñaki Comas (IBV-CSIC), Pere-Joan Cardona (CIBERES), CEEISCAT and other research groups within CIBERESP, and a network of public and private laboratories, that was subsequently implemented whithin the Tuberculosis Prevention and Control Program (Dept. de Salut, Generalitat de Catalunya), with the following objectives:

• To characterise by WGS how TB is being transmitted in Catalonia and its determinants, in order to improve the control and prevention of this infection to ultimately implement and integrate MTBC genomics into formal epidemiological surveillance activities in Catalonia.
• To evaluate the use of WGS as the new reference methodology for the detection of resistance markers in the clinical microbiology laboratory.

In 2024, a new project has been granted for the design and piloting of a new decentralized screening strategy of tuberculosis, integrated into viral hepatitis and HIV/STI screening programs in vulnerable populations.

Antimicrobial resistant bacteria

• Genomic epidemiology of outbreaks and circulating strains of multidrug-resistant bacteria, including carbapenemase or extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae and/or, vancomycin-resistant Enteroccocus faecium, or methicillin-resistant Staphylococcus aureus.
• Validation of molecular assays for the diagnosis of bacterial infections and resistance genes in collaboration with industry. The group has especially worked in the molecular diagnostics of sepsis, a time-dependent syndrome that represents the main cause of death by infection worldwide, therefore shortening the time to microbiological diagnosis saves lives. More recently, a real-time 16S rRNA sequencing assay from direct clinical samples is being validated for the microbiological diagnosis of infections that need an urgent diagnosis and conventional diagnostics methods show limitations.

Sexually Transmitted Infections (STI)

The prevalence of STIs is currently increasing worldwide. This research group has optimised various diagnostic techniques adapted for minimally-invasive sampling (especially urine, saliva, and fingerpick blood) for the screening of STI in vulnerable populations attending alternative testing centers, contributing to their epidemiological characterization with public health applications. It has also performed molecular diagnostics and epidemiology studies of human Papillomavirus (HPV), Treponema pallidum, and Monkeypox virus.

Pilot hepatitis C simplified screening and linkage to treatment strategy in community pharmacies (HepTestFarma)

PI: Elisa Martró
Funding agency: Becas Gilead a Proyectos de Microeliminación en Hepatitis C (5ª Convocatoria, 2022)
Agency code: GIL181
Duration: 01/01/2023 - 31/12/2024

Cost-effectiveness of a community intervention versus a healthcare-based strategy for promoting the prevention, diagnosis and treatment of hepatitis B and C in immigrants in Catalonia (HepBClink)

PI: Elisa Martró
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: PI19/0568
Duration: 01/01/2020 - 31/12/2024

New decentralized screening strategy of tuberculosis, integrated into viral hepatitis and HIV/STI screening programs in vulnerable populations (IntegraTB)

PI: Elisa Martró
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: PI23/00528
Duration: 01/01/2024 – 31/12/2026

Brand-specific COVID-19 vaccine effectiveness against severe COVID-19 disease in Europe (COVIDRIVE)

PI: International consortium coordinated by FISABIO; PI at IGTP: Irma Casas
Funding agency: P-95 CVBA Development Aid
Agency code: COVIDRIVE
Duration: 24/05/2021 - 31/05/2024
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Defining the best strategy for global HCV screening, linkage-to-care, education and prevention in PWID population

PI: Sabela Lens
Funding agency: Gilead Sciences, Inc (Foster City CA, EEUU) (HCV CHIME program: Conquering Hepatitis vIa Micro-Elimination)
Duration: 01/10/2018 – 30/09/2024

Epidemiological modelling of SARS-CoV2 in a post-pandemic surveillance context: an open platform for mid-term scenarios and short-term predictions

PI: Clara Prats Soler
Funding agency: Fundación BBVA
Duration: 01/07/2022 - 30/06/2024

Grup de Microbiologia Clínica i Patologia Infecciosa Experimental. Ajuts de suport als grups de recerca consolidats de Catalunya

PI: Pere-Joan Cardona
Funding agency: Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR)
Agency code: 2021 SGR 00931
Duration: 2022 - 2024

Consolidation of WGS and RT-PCR activities for SARS-CoV-2 in Spain towards sustainable use and integration of enhanced infrastructure and processes in the RELECOV network (RELECOV 2.0)

PI: Inmaculada Casas (ISCIII); PI at IGTP: Pere-Joan Cardona
Degree of contribution: Steering Committee
Funding agency: Horizon Europe: EU4H Project Grants
Agency code: EU4H-2022-DGA-MS-IBA-01-02
Duration: 01/07/2023 – 30/06/2025
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Screening of bloodborne viruses in the emergency department of Hospital Germans Trias i Pujol

PI: Rosa Mª Morillas, Elisa Martró, Anna Carreres, Eugènia Negredo
Funding agency: Gilead Sciences, S.L.U.
Agency code: FOCUS Program
Duration: 27/06/2022 – 26/09/2024

Centre de suport del Programa de Vigilància de la Tuberculosi a Catalunya

PI: Pere-Joan Cardona
Funding agency: Departament de Salut, Generalitat de Catalunya
Agency code: GC106/2022
Duration: 2022 -2024

Population-based genomic epidemiology study for tailored strategies for surveillance and control of tuberculosis (TB-SEQ)

PI: Elisa Martró. Co-PI: Iñaki Comas
Funding agency: CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCII)
Agency code: ESP22PI06
Duration: 01/01/2022 - 31/12/2023
Video

Genomic epidemiology of SARS-CoV-2 in Catalonia: virologic surveillance and outbreak control

PI: Marc Noguera (IrsiCaixa). Co-PI: Elisa Martró (IGTP, CIBERESP)
Funding agency: Fundació Marató de TV3
Agency code: 342/C/2021
Duration: 23/09/2021 - 22/09/2023

Enhancing Whole Genome Sequencing (WGS) and/or Reverse Transcription Polymerase Chain Reaction (RT-PCR) national infrastructures and capacities to respond to the COVID-19 pandemic in the EU and EEA

PI: Cristobal Belda Iniesta (ISCIII) ; PI at IGTP: Ignacio Blanco, Pere-Joan Cardona
Funding agency: European Centre for Disease Prevention and Control (ECDC)
Agency code: ECDC.HERA.2021.024
Duration: 03/09/2021 - 30/09/2022

Development of Robust and Innovative Vaccine Effectiveness (IMI-DRIVE_3)

PI: International consortium coordinated by FISABIO. PI at IGTP: Guillermo Mena, Irma Casas
Funding agency: Innovative Medicines Initiative
Duration: 15/09/2021 - 30/06/2022

Title: Micro-elimination of hepatitis B and C in vulnerable populations through new strategies for the promotion of education, screening and treatment
Author: Anna Not
Director: Elisa Martró
University: Universitat Autònoma de Barcelona (UAB)
Date of defense: expected in 2024

Title: Feasibility and acceptability of new models of hepatitis B care among African populations: implications for achieving the WHO viral hepatitis elimination targets.
Author: Camila Picchio (ISGlobal)
Directors: Jeffrey V. Lazarus, Elisa Martró
University: Universitat de Barcelona (UB)
Date of defense: 11/2023

Title: Improving the diagnosis and molecular characterization of viremic infection by the Hepatitis C virus in people who inject drugs
Author: Adrián Antuori (HUGTiP)
Directors: Elisa Martró, Verónica Saludes
University: Universitat Autònoma de Barcelona (UAB)
Date of defense: 03/2022