Principles for implementing a population screening strategy for hepatitis C in Spain

Current characteristics of patients with hepatitis C virus: results from an automated alert system

Alert systems are proving to be useful to increase hepatitis C virus (HCV) diagnoses and facilitating access to antiviral treatment. Since 2020, our health department has had a fully automated alert system set up at the Microbiology Department. In this study, we present the results of the 2022-2023 period to assess the current characteristics of HCV diagnosed patients. In addition, we analyzed, through a comparison, whether a limitation that we noticed during the 2020-2021 period (whose results were published) is still present. This limitation consists of that 24.2% (34/134) of those candidates for antiviral treatment were not treated because they could not be located or refused treatment. During the 2022-2023 period, 188 new cases were diagnosed, and 75% (141/188) were treated. The comparison of both periods showed that in 2022-2023, the rate of treatment rejection by the patient was significantly lower (1.4% vs 14.5%, p < 0.05) and, therefore, the rate of antiviral treatment increased (75% vs 58.9%, p < 0.05). These results suggest that our alert system is useful and efficient for the diagnosis and treatment of HCV.

Active search for hepatitis C patients in Primary Care

INTRODUCTION

Undiagnosed hepatitis C virus (HCV) active infections pose a problem to achieve the WHO (World Health Organization) hepatitis C elimination goal in 2030. One of the possible strategies to identify these patients is the active search for patients in Primary Care (PC).

METHODS

We reviewed patient´s medical record in PC with a "hepatitis C" open case in the last five years. We included those with uncompleted diagnostic study - due to the absence of active infection confirmation -, or those who did not start or finish treatment. A blood analysis was recommended to prove the existence of the active infection. The one-step diagnosis (OSD) was implemented to assess the viremia in all patients with a new serologic diagnosis.

RESULTS

Of 253 cases with a "hepatitis C" open case in their medical records, 24.1% (61) did not finished the diagnostic study or did not follow the treatment. Four of them were not suitable candidates to finish the study. Of the other 57, 92.9% accepted diagnostic test. Active infections were confirmed in 40 patients (75.4%) and the treatment was completed in all of them.

CONCLUSIONS

Active search for patients with hepatitis C in PC together with the OSD are effective measures to detect hidden infections and to increase the number of treatments, contributing to the elimination of hepatitis C.

Prevalence and detection of undiagnosed active hepatitis C virus infections in Navarre, Spain, 2017-2019

BACKGROUND

undiagnosed active hepatitis C virus (HCV) infection remains an obstacle towards its eradication. This study aimed to estimate the prevalence of HCV infection and to describe the diagnostic advances in Navarre, Spain.

METHODS

HCV-infection diagnostic performance was analyzed in Navarre's primary and specialized health care between 2017 and 2019. The prevalence of undiagnosed infections was estimated for patients with programmed surgeries unrelated to HCV infection, who underwent a routine HCV antibody (anti-HCV) determination. HCV-RNA (viral load) was quantified in anti-HCV positive cases. The prevalence was standardized according to the sex and age distribution in the general population.

RESULTS

from the 63,405 subjects examined for anti-HCV, 84 (five per 100,000 person-years) were diagnosed with an active infection. In Primary Health Care, 20,363 patients were analyzed and 47 active infections were detected, i.e. one case for every 433 people tested, implying 56 % of all identified active infections. On the other hand, 9,399 surgical patients were analyzed and 120 anti-HCV positive cases were detected (adjusted prevalence: 1.47 %; 95 % CI: 1.24-1.52). A positive viral load had been determined at any time in 66 cases (0.61 %), of which five were undiagnosed active infections (adjusted prevalence: 0.04 %; 95 % CI: 0.01-0.11). Preoperative screening allowed the detection of one undiagnosed infection per 795 people analyzed aged between 45 and 64 years.

CONCLUSIONS

Primary Health Care efficiently contributes to the detection of undiagnosed HCV active infections. This may be speeded up by performing population screening, targeting subjects between 45 and 64 years of age.

Reflex testing. A key tool for the elimination of hepatitis C

Hepatitis C is a major cause of liver cirrhosis and hepatocellular carcinoma, as well as the primary indication for liver transplant in Europe. The highly effective direct-acting antivirals currently available make it possible to achieve the hepatitis C elimination targets set by the World Health Organization. For this, population screening and reflect testing are fundamental strategies.