Table 6.
Integrated screening programs in psychiatric 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 |
| Freudenreich, O, 2007 [89] |
2003-2004 |
Psychiatric patients (most schizophrenia) |
USA (1.9%): Boston |
Clozapine outpatient clinic (psychiatric patients) |
4 months |
None |
No |
NR |
Scr. uptake: 100% (98/98) |
Most common risk factors: - Polysubstance abuse |
All patients were referred to a specialist; after two years, none had started treatment. One patient became unstable psychologically after the discovery of his infection. |
| Prevalence: 8.2% (8/98; 95% CI: 4.2-15.3) (incl the one known before)* | |||||||||||
| Outcomes: RNA rate: 50.0% (4/8) Start treatment: 0% (0/8) SVR: - | |||||||||||
| Gunewardene, R, 2010 [90] |
NR |
Psychiatric patients |
Australia (2%): in a capital city |
Acute psychiatric inpatient unit within an Area Health service in Australia. Comparison of two strategies. |
6 months |
None |
Unit A: No; Unit B: Yes (IDU, exposure to contaminated blood products) |
NR |
Scr. uptake: Unit A: 79.8% (95/119) Unit B: 90.0% (36/40) Prevalence: Unit A: 3.2% (3/95; 95% CI: 1.1-8.9); |
Most common risk factors: - History of IDU |
All patients were offered post-test counseling and were referred to a specialist (no results reported). Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
| Lacey, C, 2007 [91] | 2002-2003 | Psychiatric patients | Australia (2%): Melbourne, Victoria | Inner city public hospital (psychiatric) | 6 months | None | Yes; Patients admitted with psychotic or affective disorders, >18 yrs, inpatient stay >2 days, and did not have known HCV infection | Yes | Scr. uptake: 20.5% (71/346) Prevalence: 19.7% (14/71; 95% CI: 12.1-30.4)* |
Most common risk factors: - History of IDU - Sharing injection equipment |
All positive patients received post-test counseling and were referred to a specialist (no results reported). Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
Note: CI = confidence interval; NR = not reported; IDU = injecting drug use; HCV = hepatitis C virus; SVR = sustained virological response.
*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 (see ***), 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).