Hepatitis C screening and referral for further investigation and treatment in a tertiary care hospital

Management of in- and out-of-hospital screening for hepatitis C

Because of insidious progression and no significant clinical symptoms at early stage, chronic hepatitis C (CHC) is often diagnosed after the occurrence of cirrhosis and hepatocellular carcinoma. Highly effective and low drug resistance of direct-acting antiviral agents (DAAs) have enabled cure of CHC, encouraging the World Health Organization to propose a global viral hepatitis elimination program. To Date, vaccine for CHC is still under research. Therefore, reducing the source of infection is an important means of eliminating CHC other than cutting off the transmission route, which requires screening, diagnosing and treating as many patients in the population as possible. Hospital-based screening strategy have been found to be cost-effective in the management of CHC screening, as reported both nationally and internationally. Currently, China has issued In-hospital process for viral hepatitis C screening and management in China (Draft) in April, 2021, which provides a standardized implementation process and direction for in-hospital hepatitis C screening and treatment, but still requires medical institution to develop its own management process, taking into account its current situation and learning from domestic and international experience. In addition, screening for CHC outside the hospital among special populations, such as blood donors, pregnant women, homosexuals, intravenous drug users, prisoners, and residents in rural areas with scarce medical care resources, also requires attention and development of targeted and rational screening strategies. In this paper, we analyze and recommend the management of hepatitis C screening from both in-hospital and out-of-hospital perspectives, with the aim of contributing to the formulation of hepatitis C screening strategies.

Assessment of HCV-RNA test results and access rates to antiviral treatment in patients with anti-HCV positivity-a 10-year analysis

BACKGROUND

Currently, hepatitis C virus (HCV) infection can be cured by direct-acting antivirals (DAAs). In this study, we aimed to find the rate of viremia among patients with a positive anti-HCV test and the rate of antiviral treatment given to viremic patients. We also aimed to reach patients with anti-HCV positivity but not tested for HCV-RNA, and patients, who were diagnosed with HCV-RNA positivity but received no treatment.

METHODS

In this study, individuals tested for anti-HCV in Tokat Gaziosmanpaşa University Research and Application Hospital in the period between January 2010 and January 2020 were reviewed retrospectively. Anti-HCV positive patients, who were not tested for HCV-RNA, and HCV-RNA positive patients, who did not receive treatment, were called for a follow-up visit in the outpatient clinic.

RESULTS

: The prevalences of anti-HCV positivity and viremia among patients were 2.24% and 0.67%, respectively. A HCV-RNA test was ordered in 71.7% of the anti-HCV positive patients. Antiviral treatment was not given to 44.4% of the viremic patients. Of the patients, who were called for a follow-up visit in the outpatient clinic, 3.9% attended the visit. Of these patients, 0.8% were HCV-RNA positive and 0.7% received treatment.

DISCUSSION

Although the rate of HCV-RNA testing was relatively high in patients with anti-HCV positivity, almost half of them did not receive treatment. We could reach only one-third of the patients, who were called for a follow-up visit, and only a few patients received treatment. Individuals with anti-HCV positivity should be referred to a specialist without delay and HCV-RNA testing should be performed immediately to achieve HCV elimination targets. The likelihood of difficulties in reaching patients later should be considered.