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 Feb 11;15(2):e0228351. doi: 10.1371/journal.pone.0228351. eCollection 2020.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents / therapeutic use
  • Cross-Sectional Studies
  • Female
  • Hepacivirus / genetics
  • Hepacivirus / isolation & purification
  • Hepatitis C / diagnosis*
  • Hepatitis C / drug therapy
  • Hepatitis C / epidemiology
  • Hepatitis C Antibodies / blood*
  • Humans
  • Male
  • Middle Aged
  • Point-of-Care Systems
  • Prevalence
  • RNA, Viral / analysis
  • Risk Factors
  • Sustained Virologic Response
  • Urban Population
  • Young Adult

Substances

  • Antiviral Agents
  • Hepatitis C Antibodies
  • RNA, Viral

Associated data

  • Dryad/10.5061/dryad.9ghx3ffdd

Grants and funding

This study was supported by two competitive grants from the Instituto de Salud Carlos III (www.isciii.es) (PI15/02010, co-financed by the European Regional Development Fund), and the Gilead/Instituto de Salud Carlos III Fellowship Program (GLD1400269) (http://www.fellowshipgilead.es/). MB was also supported by the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) (https://www.ciberehd.org/) and FXLL by the Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp) (https://www.ciberesp.es), both funded by the Instituto de Salud Carlos III (co-financed by the European Regional Development Fund). TDM received a Río Hortega Fellowship from the Instituto de Salud Carlos III (CM15/00133; co-financed by the European Social Fund), and AC received a FP Fellowship from Bankia (https://www.bankia.es/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.