Table 5.
Integrated screening programs in antenatal/obstetric/fertility clinics
|
Program characteristics |
Program outcomes |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| First author, year of publication | Calendar year of data collection | Population | Country and HCV prevalence according to CDC[23] | Setting of screening | Duration of screening program | Other tests | Prescreening selection | Media activities | Screening uptake and anti-HCV prevalence (95% CI) | Risk profile of identified HCV cases/Risk factors associated with HCV | Follow-up of HCV-infected individuals |
| Alexanian et al. 2009 [84] |
NR |
Pregnant women |
UK (1.1%): London |
Antenatal clinic |
8 years, Hospital records search |
HBV, HIV |
No |
NR |
Scr. uptake: NR |
NR |
In total, 73.0% (84/115) of patients had chronic HCV, of whom 55.9% (47/84) were lost to follow-up, 10.7% (9/84) deferred treatment, 4.8% (4/84) were on treatment, and 17.9% (15/84) completed treatment. Of these 15, 12 achieved SRV, 1 relapsed, and two failed to respond. |
| Prevalence: 0.4 (115/31081; 95% CI: 0.3-0.4)* | |||||||||||
| Outcomes: RNA rate: 73.0% (84/115) Start treatment: 67.9% (19/28) SVR: 80.0% (12/15) | |||||||||||
| Abusheikha et al. 1999 [85] |
1996-1998 |
Couples receiving fertility treatment |
UK (1.1%): Cambridge |
Bourn Hall clinic, infertility hospital |
3 years |
HIV, HBV |
No |
NR |
Scr. uptake: NR Prevalence: 0.5% (9/1658; 95% CI: 0.3-1.0)** |
NR |
All patients were counseled by senior medical staff. Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
| Leikin et al. 1994 [86] |
1991-1992 |
Pregnant women who are at risk for perinatal complications |
USA (1.9%): Valhalla |
Hospital (obstetric) |
19,5 months |
ALT |
No |
NR |
Scr. uptake: NR Prevalence: 4.6% (78/1700; 95% CI: 3.7-5.7)* |
Multivariable regr. analysis: - History of IDU - Other drug use - Age > 30 - Incarceration - Blood transfusion |
In total, 96.2% (75/78) of the patients returned for follow-up. No further details reported. Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
| Ward et al. 2000 [87] |
1997-1999 |
Pregnant women |
UK (1.1%): London |
Antenatal clinic |
18 months |
HBV |
No |
Yes |
Scr. uptake: 98.0% (4727/4825) Prevalence: 0.8% (38/4729; 95% CI: 0.6-1.1)*** |
Univariate regr. analysis: - History of IDU - HCV-infected partner - Tattoo - Partner IDU |
In total, 71.1% (27/38) had chronic HCV, and 85.2% (23/27) were offered follow-up appointments so far. Of those, 82.6% (19/23) attended for further investigations. Outcomes: RNA rate: 71.1% (27/38) Start treatment: NR SVR: NR |
| Costa et al. 2009 [88] | 2004-2005 | Pregnant women | Brazil (1%): Central Brazil, Goiania | Antenatal clinics | NR | HIV and seven other infectious diseases (not specified) | No | NR | Scr. uptake: 99.9% (28561/28576) Prevalence: 0.2% CHCV (43/28561; 95% CI: 0.1-0.2%)**** |
Multivariable regr. analysis: - Older age - >3 pregnancies(no data on risk factors collected) |
Patients were referred for free of cost medical counseling (no results reported). Outcomes: RNA rate: n/a Start treatment: NR SVR: NR |
Note: CI = confidence interval; NR = not reported; IDU = injecting drug use; HCV = hepatitis C virus; CHCV = chronic hepatitis C virus; HIV = human immunodeficiency virus; HBV = hepatitis B virus; ALT = alanine aminotransferase; SVR = sustained virological response; PCR = polymerase chain reaction.
*HCV-antibody prevalence is considered suboptimal (data were collected before 1994 when sensitivity/specificity of tests was not optimal, or reactive HCV-antibody test results were not confirmed by immunoblot).
**The reliability of the reported HCV-antibody prevalence is undecided (data were collected after 1993, but the diagnostic tests are unspecified, or other than described below, or dried blood spots or oral fluid samples were used).
***HCV-antibody prevalence is considered valid; data were collected after 1993, and reactive HCV-antibody test results were confirmed by second or higher generation immunoblot assays from Ortho, Chiron, Novartis (RIBA), Innogenetics (LiaTek), Pasteur (DECISCAN HCV), Genelabs Diagnostics (HCV BLOT), or Mikrogen (recomBlot HCV IgG 2.0).
****HCV-antibody prevalence is considered valid, but reflecting chronic HCV infection (data were collected after 1993, and reactive HCV antibody test results were confirmed by PCR).