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Carvalho-Gomes Â, Cubells A, Pallarés C, Hontangas V, Conde I, Di Maira T, Peiró S, Sanfélix-Gimeno G, López-Labrador FX, Berenguer M. A population-based screening for hepatitis C antibodies and active infection using a point-of-care test in a low prevalence area. PLoS One 2020; 15:e0228351. [PMID: 32045417 PMCID: PMC7012430 DOI: 10.1371/journal.pone.0228351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Data on the true prevalence of hepatitis C virus (HCV) infection in the general population is essential. We evaluated a program implementing free universal HCV screening using a non-invasive point-of-care test (POCT) (OraQuick-HCV rapid test) in oral fluid in an urban area in Valencia, South-Eastern Spain. Methods A cross-sectional study was performed during 2015–2017. Free HCV screening was offered by regular mail to 11,500 individuals aged 18 and over, randomly selected from all census residents in the Health Department. All responding participants filled in a questionnaire about HCV infection risk factors and were tested in their tertiary Hospital. In those with a positive POCT, results were confirmed by enzyme-immunoassay and HCV-RNA. Results 1,206 persons agreed to participate (response rate: 11.16%). HCV antibodies were detected in 19 (1.60%) cases (age-sex standardized rate: 1.31%; 95%CI: 0.82–2.07), but only 8 showed positive HCV-RNA (age-sex standardized rate: 0.56%; 95%CI: 0.28–1.14). The majority (89%) of the cases were born before 1965 and 74% had at least one known risk factor for HCV infection. All anti-HCV positive individuals were already aware of their infection, and no undiagnosed cases were detected. The performance of the POCT was excellent for detecting active infection. Conclusions These preliminary data suggest that HCV population screening with a POCT is feasible but, in our setting, mailing recruiting is not effective (11% response rate). The low prevalence of HCV antibodies and active infection in the participant population (with no new diagnoses made) suggests that, in our setting, underdiagnosis may be uncommon.
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Affiliation(s)
- Ângela Carvalho-Gomes
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Almudena Cubells
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
| | - Carmina Pallarés
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Hontangas
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
| | - Isabel Conde
- Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, València, Spain
| | - Tomasso Di Maira
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
| | - Salvador Peiró
- Health Services Research Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO Public Health), València, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO Public Health), València, Spain
| | - F. Xavier López-Labrador
- Virology Laboratory, Joint Units in Genomics and Health and Infection and Health, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO Public Health) / Universitat de València, València, Spain
- CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Marina Berenguer
- Liver Transplantation and Hepatology Laboratory, Instituto de Investigación Sanitaria La Fe, València, Spain
- CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
- Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, València, Spain
- Department of Medicine, Universitat de València, València, Spain
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Pallarés C, Carvalho-Gomes Â, Hontangas V, Conde I, Di Maira T, Aguilera V, Benlloch S, Berenguer M, López-Labrador FX. Performance of the OraQuick Hepatitis C virus antibody test in oral fluid and fingerstick blood before and after treatment-induced viral clearance. J Clin Virol 2018. [PMID: 29525634 DOI: 10.1016/j.jcv.2018.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A reliable population screening strategy for hepatitis C virus (HCV) infection may be based in easy-to-use point-of-care (POC) tests for HCV antibodies, but validation data is needed before their potential widespread use in primary care or outreach practice. Besides, the sensitivity of these POC tests in patients with spontaneous or treatment-induced viral clearance is unknown. OBJECTIVES To test the performance of a non-invasive POC anti-HCV test (OraQuick HCV rapid test) in oral mucosal transudate (OMT) and fingerstick blood from patients with known anti-HCV serostatus and with or without active viremia (after treatment-induced clearance). STUDY DESIGN A risk factor questionnaire was collected from 317 consecutive patients (anti-HCV positive/HCV-RNA positive n = 107; anti-HCV positive/HCV-RNA negative after antiviral treatment n = 107; anti-HCV negative with other liver diseases n = 109) before performing the OraQuick HCV rapid test in OMT (n = 317) and fingerstick blood (n = 251). We calculated the sensitivity and specificity of the test by using anti-HCV serostatus as the reference gold-standard. RESULTS Among all anti-HCV seropositive patients, the clinical sensitivity and specificity of the OraQuick HCV rapid test in OMT was 89.9% and 100%, respectively. In fingerstick blood, the sensitivity improved to 98.8%. The sensitivity was higher in OMT (97.2%) in anti-HCV seropositive patients who were viremic as compared to that in non-viremic individuals (82.2%). In contrast, there were no significant differences in sensitivity between viremic and non-viremic individuals when testing fingerstick blood. Finally, extension of the read time to 40 min enhanced the sensitivity, especially in OMT (up to 94.7%) and in the subgroup of non-viremic, anti-HCV-positive patients (up to 90.1%). CONCLUSIONS The OraQuick HCV rapid test in OMT has a high sensitivity and specificity for detecting active HCV infection that decreases substantially in anti-HCV positive/HCV-RNA negative patients with treatment-induced viral clearance. For these individuals, extension of read times and testing fingerstick blood showed improved sensitivity.
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Affiliation(s)
- Carmina Pallarés
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Ângela Carvalho-Gomes
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Hontangas
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain
| | - Isabel Conde
- Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Tomasso Di Maira
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain
| | - Victoria Aguilera
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Salvador Benlloch
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marina Berenguer
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Medical School, Universitat de València, Spain
| | - F Xavier López-Labrador
- Virology Laboratory, Genomics and Health Area, Center for Public Health Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Public Health), Generalitat Valenciana, Valencia, Spain; CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
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