State of the Globe: Hepatitis C – Opportunistic versus Organized Screening

Saini et al. have reported a rise in hepatitic C virus (HCV) infection rate among the blood donors in Central India.[1]

HCV-related deaths per year are on the rise. The 2015 Global Burden of Disease study showed that the estimated number of deaths due to hepatitis C in 1990 and 2013 was 333,000 and 704,000, respectively.[2,3] This indicates that there is a continuous increase in incident cases of hepatitis C, which may be largely attributable to the increased use of parenteral preparation and injection drug use.[4] Although with the universal screening of blood for HCV, a decline in incidence has been observed, still a large number of cases of hepatitis C continue to suffer from HCV-related cirrhosis and hepatocellular carcinoma.[5]

The global resurgence in HCV cases has been noticed, especially in injection drug users and HIV-infected men who have sex with men.[6,7] A systematic review in 2013 estimates that about 184 million persons have a history of HCV infection (anti-HCV antibody) and about 130–150 million out of these may have chronicity (HCV RNA positive).[8] Although the recent reviews may point toward a lower prevalence, the number of people needing treatment for complications of HCV remains quite high.[9] A 5-year data analysis on the seroprevalence of transfusion-transmitted infections among blood donors in an Indian setting revealed that though the prevalence had decreased over a 5-year period but was still significant.[10]

RECOMMENDATIONS ON SCREENING

Two strategies for screening have been in use: first one uses organized screening programs (through mass or high-risk screening programs) to identify people with HCV infection and the second approach is that of opportunistic screening. Opportunistic screening is easy and sustainable; the organized screening needs the establishment of services at various health-care delivery setups with uniform standards and may not be financially viable. As it is obvious from the estimates derived till now, a large number of people will have to be invited to take part in these organized screening programs to be successful.

The opportunistic screening for HCV can be conducted as and when someone asks for it or it can be offered at the time of blood testing for some other purposes. Unlike an organized screening program, opportunistic screening need not be monitored, and the cost will be minimal. Since we all seek or receive a health test or checkup in our lifetimes, the yield from such opportunistic screening programs will be substantial.

As an early guideline for conducting opportunistic screening, the World Health Organization list on populations with a high HCV prevalence or a history of HCV risk exposure/behavior will be useful.[11]

1. Any individual who received medical or dental interventions in health-care settings with below standard infection control practices

2. Any individual who has received blood transfusions before serological testing of blood donors for HCV was initiated

3. Any individual who has received blood transfusions in a country where serological testing of blood donations for HCV is not routinely performed

4. People who inject drugs

5. Any individual who have had tattoos, body piercing, or scarification procedures in a setting where infection control practices are below standard

6. Children born to mothers infected with HCV

7. HIV-infected individuals

8. Individuals use/using/have used intranasal drugs

9. Prisoners and previously incarcerated persons.