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HEPATITIS C SCREENING IN THE GENERAL POPULATION IN A FRENCH CITY: A NEEDLE IN A HAYSTACK
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AASLD 2020 Nov 11-16
Reported by Jules Levin
HCV incidence is increasing in the USA. Why? No funded screening, in NYC what are the numbers?
Background: Concerning the WHO objectives for eliminating viral hepatitis by 2030, the efficiency of universal screening compared to screening targeting those most at risk is still debated. Aim: To evaluate the prevalence of viral infection C (Ab+) and chronic hepatitis C (RNA+) through a general population screening campaign at a French city level
Methods: This project was initiated by a consortium including the Regional Hepatitis Network, a patient association, the town hall, the medical analysis laboratories, the Regional Health Agency, Public Health France, the Regional Union of Liberal Health Professionals, Public health insurance funds . In addition to the usual circuit based on the medical prescription, screening without a prescription was organized and facilitated . Initially, HCV serology was determined with a proposal to carry out a more complete serological screening - HIV, HBV, syphilis. In patients with positive serology, HCV RNA testing was proposed . In all participants, a risk factor analysis questionnaire was proposed. During the month preceding the screening period, an information campaign was put in place through posters in the laboratories,advertising on public transport, and several press conferences .
Results: Between 09/2019 and 12/2019, 10,323 screening tests were carried out in 10,143 participants, 8.7% of whom were without a prescription (8461 tests over the same period in 2018). The prevalence of HCV Ab was 0 .89%, 0 .97% with a prescription and 0 .34% without a prescription . It was 1 .12% in 2018 . Concerning the associated tests, 8289 HIV (0 .34% +) 7328 HBV (0 .57% +) and 5724 syphilis (1 .42% +). There were 60 .3% women, 70% between the ages of 20 and 49 years old . 5334 questionnaires were completed: 37% declared having no known risk factors . Among the 3173 participants who provided information on at least one risk factor, 33 .5% reported a medical-surgical procedure, 33.5% a miscellaneous procedure (tattooing, piercing), 9 .8% traumatic sexual intercourse, 6 .8% drug use, 3 .9% a relative with HCV, 10 .6% care abroad, and 1 .9% a transfusion. Among the 90 patients with positive serology: ther were more men (59%), 83% > 40 years old, and all 30 respondents to the questionnaires reported at least one risk factor, mostly medical procedures and drug use . 69/90 had an RNA search, 19 lost of follow-up and 1 treated in 2018. 9 patients had RNA+ and all of these patients were managed to initiate treatment.
Conclusion: This study of screening in the general population at the level of a French city confirms the decrease in the prevalence of viral infection C and underlines the rarity of chronic hepatitis C . It emerges from this campaign that increased screening in people over 40 years of age is desirable.
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