Hepatitis C virus core antigen is cost-effective in community-based screening of active hepatitis C infection in Taiwan

Wang, Jing‐Houng; Chen, Chien‐Hung; Chang, C. L.; Feng, Wen-Chin; Lee, Chih-Yi; Lu, Sheng–Nan

doi:10.1016/j.jfma.2019.07.011

Cited by 18 publications

(18 citation statements)

References 20 publications

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“…Furthermore, HCV Ag assay may be superior to the current two-step diagnostic approach in terms of time and cost saving benefits. The novel approach has also established its clinical utility in the screening of active HCV infections amongst anti-HCV antibody positive individuals [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical utility of hepatitis C virus core antigen assay in the monitoring of direct-acting antivirals for chronic hepatitis C

et al. 2020

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Background Hepatitis C virus core antigen (HCV Ag) assay has been proposed as a more economical alternative to HCV RNA detection. This study aimed to investigate the clinical utility of HCV Ag assay in the monitoring of direct-acting antivirals (DAAs) for chronic hepatitis C patients. Methods We analyzed serum samples from 110 patients treated with paritaprevir/ritonavir, ombitasvir, and dasabuvir (PrOD) with or without ribavirin. The levels for both HCV Ag and HCV RNA assessed by COBAS TaqMan HCV (CTM) Test or Abbott RealTime HCV (ART) assay were evaluated at baseline, week 2, 4, and 12 during treatment and 12 weeks after completion. Results Baseline HCV Ag levels showed good correlations with HCV viral load (r = 0.879; p<0.001); whereas the correlation was slightly stronger with CTM test than with ART assay (p = 0.074). The concordance of HCV Ag and HCV RNA undetectability was significantly better in CTM test than in ART assay at week 2 (p = 0.003) and week 4 (p = 0.003). A sustained viral response 12 weeks off therapy (SVR 12) was achieved in 108 patients (98%); the HCV Ag assay identified 99% of these patients. Both undetectability of serum HCV Ag and HCV RNA had high positive predictive value at week 2 (98% vs. 100%) and at week 4 (97% vs. 99%) in predicting SVR 12. Conclusions HCV Ag assay may be a feasible alternative to HCV RNA for the determination of SVR 12 in patients treated with DAAs.

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Section: Introductionmentioning

confidence: 99%

Clinical utility of hepatitis C virus core antigen assay in the monitoring of direct-acting antivirals for chronic hepatitis C

et al. 2020

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“…This efficacious strategy facilitates a 'one stop testing' and allows for precise referral while mitigating unnecessary patient transportation and is expected to reduce the number of patients lost to follow-up. Moreover, our results reveal a high proportion of anti-HCV-positive individuals and HBsAg-positive individuals who were actually not viremic or did not require treatment; these findings suggest that prevalence-screening approaches that focus on individuals with detectable HBsAg or anti-HCV should be 28 A study investigating the acceptability and feasibility of a screen-and-treat programme using point-of-care HBsAg screening in The Gambia revealed that knowledge about HBV infection was extremely low in local communities. 29 This programme linked up to 81.3% of HBsAg-positive individuals to care, constituting a high linkage rate.…”

Section: Discussionmentioning

confidence: 55%

“…12 Technically, the feasibility and costeffectiveness of this single-step strategy would be increased if HCV RNA testing is replaced by the cheaper HCV core antigen (HCV Ag) testing in an outreach screening setting. 13 For HBV, research revealed that linking HBsAg screening to HBV treatment is cost-effective, even at low HBsAg prevalence levels. 14 However, not all individuals positive for HBsAg or anti-HCV experience the same disease consequences; hence, prioritising only treatmenteligible individuals for referral can prevent futile and tiring journeys for those residing in remote and resourcelimited regions.…”

Section: Open Accessmentioning

confidence: 99%

Village-to-village screening for hepatitis B and C using quantitative HBsAg and anti-HCV testing with reflex HCV core antigen tests in the remote communities of a resource-rich setting: a population-based prospective cohort study

Chang

Chen

et al. 2021

BMJ Open

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ObjectivesCommunity-based screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) is essential for hepatitis elimination. This study attempted to increase screening accessibility and efficacy by using alternative tools.DesignPopulation-based prospective cohort study.SettingHepatitis elimination program at Yunlin County, Taiwan.ParticipantsAll 4552 individuals participated in 60 screening sessions of a community-based HBV and HCV screening project in five rural townships with approximately 95 000 inhabitants in central-western Taiwan.InterventionsTo increase accessibility, 60 outreach screening sessions were conducted in 41 disseminative sites. Quantitative HBV surface antigen (qHBsAg) and anti-HCV testing with reflex HCV core antigen (HCV Ag) tests were employed as alternative screening tools.Main outcome measuresCalculate village-specific prevalence of HBsAg, anti-HCV and HCV Ag and establish patient allocation strategies according to levels of qHBsAg HCV Ag and alanine aminotransferase (ALT).ResultsOf 4552 participants, 553, 697 and 290 were positive for HBsAg, anti-HCV and HCV Ag, respectively; 75 of them had both HBsAg and anti-HCV positivity. The average (range) number of participants in each screening session was 98 (31–150). The prevalence rates (range) of HBsAg, anti-HCV and HCV Ag were 12.1% (4.3%–19.4%), 15.3% (2.6%–52.3%) and 6.4% (0%–30.2%), respectively. The HCV Ag positivity rate among anti-HCV-positive participants was 42% (0%–100%). Using cut-off values of >200 IU/mL for qHBsAg, >3 fmol/L for HCV Ag and >40 IU/mL for ALT as criteria for patient referral, we noted an 80.2% reduction in referral burden. Three villages had high anti-HCV prevalences of 52.3%, 53.8% and 63.4% with corresponding viraemic prevalences of 23.2%, 30.1% and 22% and thus constituted newly identified HCV-hyperendemic villages.ConclusionOutreach hepatitis screening increases accessibility for residents in rural communities. Screening HBV and HCV through qHBsAg and HCV Ag tests provides information concerning viral activities, which might be conducive to precise patient allocation in remote communities.

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“…The rst replaces viral RNA test with core antigen tests, which can provide results in 60 minutes (23)(24)(25). Core antigen tests have been approved by the WHO as an alternative for con rmatory viral load testing (26,27), and may also provide an alternative approach for assessing SRV12 (28).…”

Section: Discussionmentioning

confidence: 99%

Time To Complete hepatitis C Cascade of Care Among Patients Identified During Mass Screening Campaigns in Rural Rwanda: A Retrospective Cohort Study

Kamali¹,

Shumbusho²,

Barnhart³

et al. 2021

Preprint

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Background Since the discovery of direct-acting antivirals, treatment for hepatitis C virus (HCV) is increasingly accessible in low-resource settings, but quality of care in these settings is not known. We described progression through the cascade of care among individuals who screened positive for HCV antibodies during a mass screening campaign in Kirehe and Kayonza, two rural Rwandan districts, in September 2019. Methods This retrospective cohort study used routine clinical data to assess proportions of participants completing each stage of the cascade of care, including: a) screening positive on rapid diagnostic test; b) return of initial viral load results; c) detectable viral load; d) treatment assessment; e) treatment initiation; f) return of sustained virological response (SVR12) results; and g) achieving SVR12. We proposed three indicators to assess timely care provision and used medians and interquartile ranges (IQR) to describe the time to complete the cascade of care. Results Overall, 666 participants screened HCV positive, among them, 452 (68.1%) were female and median age was 61 years (IQR: 47, 70). Viral load results were returned for 537 (80.6%) participants of whom 448 (83.4%) had detectable viral loads. Of these, 398 (88.8%) were assessed for treatment, 394 (99%) were initiated, but only 222 (56.3%) had results returned for SVR12. Among those with SVR12 results, 208 (93.7%) achieved SVR12. When assessing timely care provision, we found 65.9% (95% CI: 62.0, 69.7) of initial viral load results were returned ≤ 30 days of screening; 45% (95% CI: 40.1, 49.8) of people with detectable viral load completed treatment assessment ≤ 90 days of initial viral load results; and 12.5% (95% CI: 9.2,16.3) of SVR12 results were returned ≤ 210 days of treatment initiation among those who initiated treatment. The overall median time from screening to SVR12 assessment was 437 days. Conclusion Despite high rates of SVR12 among those who completed all stages of the cascade of care, we identified gaps and delays in the treatment cascade. Improving communication between viral load testing hubs and health facilities could reduce the turn-around time for viral load testing, and actively monitor timeliness of care provision could improve quality of HCV care.

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Hepatitis C virus core antigen is cost-effective in community-based screening of active hepatitis C infection in Taiwan

Cited by 18 publications

References 20 publications

Clinical utility of hepatitis C virus core antigen assay in the monitoring of direct-acting antivirals for chronic hepatitis C

Clinical utility of hepatitis C virus core antigen assay in the monitoring of direct-acting antivirals for chronic hepatitis C

Village-to-village screening for hepatitis B and C using quantitative HBsAg and anti-HCV testing with reflex HCV core antigen tests in the remote communities of a resource-rich setting: a population-based prospective cohort study

Time To Complete hepatitis C Cascade of Care Among Patients Identified During Mass Screening Campaigns in Rural Rwanda: A Retrospective Cohort Study

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