Targeted hepatitis C antibody testing interventions: a systematic review and meta-analysis

Abstract

Testing for hepatitis C virus (HCV) infection may reduce the risk of liver-related morbidity, by facilitating earlier access to treatment and care. This review investigated the effectiveness of targeted testing interventions on HCV case detection, treatment uptake, and prevention of liver-related morbidity. A literature search identified studies published up to 2013 that compared a targeted HCV testing intervention (targeting individuals or groups at increased risk of HCV) with no targeted intervention, and results were synthesised using meta-analysis. Exposure to a targeted testing intervention, compared to no targeted intervention, was associated with increased cases detected [number of studies (n) = 14; pooled relative risk (RR) 1.7, 95 % CI 1.3, 2.2] and patients commencing therapy (n = 4; RR 3.3, 95 % CI 1.1, 10.0). Practitioner-based interventions increased test uptake and cases detected (n = 12; RR 3.5, 95 % CI 2.5, 4.8; and n = 10; RR 2.2, 95 % CI 1.4, 3.5, respectively), whereas media/information-based interventions were less effective (n = 4; RR 1.5, 95 % CI 0.7, 3.0; and n = 4; RR 1.3, 95 % CI 1.0, 1.6, respectively). This meta-analysis provides for the first time a quantitative assessment of targeted HCV testing interventions, demonstrating that these strategies were effective in diagnosing cases and increasing treatment uptake. Strategies involving practitioner-based interventions yielded the most favourable outcomes. It is recommended that testing should be targeted at and offered to individuals who are part of a population with high HCV prevalence, or who have a history of HCV risk behaviour.Electronic supplementary materialThe online version of this article (doi:10.1007/s10654-014-9958-4) contains supplementary material, which is available to authorized users.

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing

“…Higher positive rates and lower numbers needed to screen to detect 1 case have been found in birth cohort studies in higher prevalence settings and countries, such as the United States. 15,26,37,42 Detected positive rates were higher in those with a hepatitis exposure risk factor, a finding in line with studies targeting risk factors. 15,26 Using a risk group instead of the birth cohort, however, would have missed 22% to 54% of all positive cases in this study (3 of 7 anti-HCV-positive cases, 2 of 9 HBsAg-positive cases, and 77 of 142 anti-HBc-positive cases).…”

“…15,26,37,42 Detected positive rates were higher in those with a hepatitis exposure risk factor, a finding in line with studies targeting risk factors. 15,26 Using a risk group instead of the birth cohort, however, would have missed 22% to 54% of all positive cases in this study (3 of 7 anti-HCV-positive cases, 2 of 9 HBsAg-positive cases, and 77 of 142 anti-HBc-positive cases). [7][8][9][10] For chronic HBV infections specifically, several studies state that systematic screening among migrants is likely to be cost-effective or at least increases its efficiency.…”

“…According to a meta-analysis, targeted practitioner-based studies are most effective in increasing test uptake and cases detected. 26 Diagnostic yield could be further optimized by focusing on areas of higher prevalence. Based on spatialepidemiological analyses of laboratory data, the estimated prevalence of HCV infection in the south of the Netherlands is 0.5%, and HCV infections are found to cluster in urban areas, with a prevalence of up to 1%.…”

Global policy and access to new hepatitis C therapies for people who inject drugs

“…The WHO Guidelines first address how best to identify people with chronic HCV infection; a systematic review examined interventions that promoted HCV testing of asymptomatic individuals [7]. This review investigated the effectiveness of targeted testing interventions on HCV case detection, treatment uptake, and prevention of liver-related morbidity.…”

Скринінг На Вірусні Гепатити: Актуальність Проблеми Та Шляхи Вдосконалення (Огляд Літератури)

“…В этом случае возможна работа с относительно малыми по численности группами риска и обследование по не-скольким показаниям одновременно. Кроме того, если тестирование проводится медицинскими работ-никами, качество скрининга намного возрастает за счет меньшего охвата, чем при организации его через средства массовой информации, при одновременном увеличении удельного веса инфицированных в обсле-дуемой популяции (врач решает точнее, чем пациент, относится ли последний к группе риска) [48,49].…”