Table 3

Integrated screening programs at general practitioner (GP) 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 Pre-screening 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
Monnet et al. 2000, 2009 [70] 1997-1998 Patient of GP clinics, health centres, occupational physicians, prison health service, public laboratories France (1.1%): Le Doubs GP clinics, health centre, occupational physicians, prison health service, public laboratories 1 year None Yes, no previous positive HCV serology, and at least having one risk factor: transfusion before 1991, (ex-)IDU, (ex-)snorting cocaine, tattoo, HCV diagnosis in living environment Yes

Scr. uptake: 82.5% (782/948)

Prevalence: 4.0% (31/782; 95% CI: 2.8-5.6)*

Multivariable regr. analysis:

- Age 30+

- Drug use

70.9% (22/31) attended the hepatologist for HCV RNA testing. Of those who tested HCV RNA positive, 10 had elevated ALAT of which 8 had a biopsy. Based on the results, 5 were indicated for treatment (no results reported).

Outcomes: RNA rate: 86.4% (19/22)

Start treatment: NR

SVR: NR

Anderson et al. 2009 [71] 2003-2004 GP patients aged 30–54 yrs Scotland (1.1%): socio-economically deprived area of Glasgow GP clinics (intervention clinic and comparison clinic) 6 months None

No; in intervention practice all individuals aged 30–54 yrs who attended non-urgent appointments were offered HCV screening.

In comparison practice, no intervention was carried out.

Eligible patients in intervention practice received information leaflet

Scr. uptake: Intervention clinic: 27.8% (117/421)

Comparison clinic: not applicable

Prevalence: Intervention clinic: 12.8% (15/117; 95% CI: 7.9-20.0)

Comparison clinic: No individuals were tested during study period.**

Multivariable regr. analysis

- History of IDU

HCV RNA positive patients (n = 11) were referred to a specialist and all attended ≥1 appointment. Four years later,

8 were lost to follow-up, 2 started treatment, and 1 achieved an SVR.

Outcomes: RNA rate: 73.3% (11/15)

Start treatment: 18.2% (2/11)

SVR: 50.0% (1/2)

Pauti et al. 2008 [44] 2007 People with poor access to health care, mostly migrants France (1.1%): Saint-Denis and Paris areas Health care and advice centers of Médecins du Mondeb 4 years, but data from 1 year are reported HIV, HBV No No

Scr. uptake: NR

Prevalence: 5.9% (70/1196; 95% CI: 4.7-7.3)**

Listed risk factors:

- North and Middle Africa

- Sub-Saharan Africa

- Eastern Europe

The objective of the project was to offer full access to treatment, but actual results are not reported

Outcomes: RNA rate: NR

Start treatment: NR

SVR: NR

Uddin et al. 2010 [46]a NR GP patients UK (1.1%): East London, West London, Walsall, Sandwell, Bradford GP clinic (and at community centers, see Additional file 1: Table S1) NR HBV Yes, immigrants from the Indian sub-continent (India, Bangladesh or Pakistan) No Scr. uptake: NR Not applicable Not applicable
Prevalence: 0% (0/171; 95% CI: 0–2.19 )**
Kallman et al. 2010 [47]a NR GP patients USA (1.9%): Northern Virginia GP clinic (and general health screening at Asian health fairs, see Additional file 1: Table S1) NR HBV Yes, Vietnamese NR

Scr. uptake: NR

Prevalence: 1.2% (3/245; 95% CI: 0.4-3.5) at GP clinic**

Univariable regr. analysis: - Elevated AST Patients were seen by their primary care givers for further management, or referred for further follow-up and treatment (no results reported).

Outcomes: RNA rate: NR

Start treatment: NR

SVR: NR

Ouzan, D, 2003 [72] 2000 GP patients aged over 18 years France (1.1%): Alpes-Maritimes district GP clinic 1 month None Yes: unknown HCV serology status, and at least one risk factor: blood transfusion before 1991, injecting or nasal DU, incarceration. Previously diagnosed HCV positives that visited the GP in the screening period were also followed-up. No

Scr. uptake: 66.0% (233/353)

Prevalence:3.9% (9/233; 95% CI: 2.0-7.02) 9 were newly identified through screening; 229 were found with a previous diagnosis**

NR for newly identified Patients were followed-up by their GP, referred to a specialist, or a hospital unit.
Follow-up data are reported for newly and previously diagnosed patients together and available for 159/238. HCV RNA test results were known for n = 106, and 82 were HCV RNA positive. A liver biopsy was performed in 62, of which 31 received treatment. Treatment was effective for 10, fairly effective for 12, and ineffective for 7.

Outcomes: RNA rate: 77.4% (82/106)

Start treatment: 37.8% (31/82)

SVR: NR

Josset et al. 2004 [73] 1997 GP patients aged 18–70 yrs France (1.1%): Haute-Normandie GP clinic 10 days None Yes, no previous HCV serology performed, and at least one of the traditional risk factors present c No

Scr. uptake: 72.7%

(3550/4883)

Prevalence: 1.4% (49/3550; 95% CI: 1.0-1.8%)**

An evaluation of screening strategies based on risk factor data showed that screening those with a history of blood transfusion or drug use appeared to be the most efficient approach.

NR

Outcomes: RNA rate: NR

Start treatment: NR

SVR: NR

Pradat et al. 2001 [74] 1997 GP patients aged 18–69 yrs France (1.1%): Lyon area GP clinics 6 months; each GP clinic offered HCV screening for 5 days None No NR

Scr. uptake: 59.0%

6876/11646

Prevalence:

0.4% (30/6876; 95% CI: 0.3-0.6)***

Listed risk factors:

- History of IDU

- Transfusion <1990

- Other risk factors

NR

Outcomes:

RNA rate: NR

Start treatment: NR

SVR: NR

Altman et al. 1999 [75] 1997 GP patients France (1.1%): Val-de-Marne and Hauts-de-Seine GP clinics 2 weeks None Yes, no previous HCV serology performed, and a history of IDU or transfusion before 1991 No Scr. uptake: NR NR

Transfusion group: 76.9% (226/294)

History of IDU group: 50.0% (13/26)

Outcomes: RNA rate: NR

Start treatment: NR SVR: NR

Prevalence: Transfusion group: 3.1% (7/226, 95% CI: 1.5-6.3)

History of IDU group: 30.8% (4/13; 95% CI: 12.7-57.6)*

Helsper et al. 2010 [76] 2007-2008 GP patients Netherlands (1.1%): Amersfoort and Apeldoorn GP clinics in intervention region with primary care practice support, and GP clinics in control region without practice support 4 months None Yes, individual risk estimation by GP Yes Scr. uptake: NR Data not available NR

Prevalence: Intervention: 1.7% (3/172; 95% CI: 0.6-5.0)

Control: 0.8% (1/118; 95% CI: 0.04-4.6)**

Outcomes: RNA rate: NR

Start treatment: NR

SVR: NR

Sahajian et al. 2004 [77] 2000-2001 GP, private practitioners, and specialist patients France (1.1%): Lyon area GP clinics Intervention: A campaign including training aimed at GPs was designed to improve screening practices. The campaign also reached the public. Comparison: Data were compared to the 12-months period preceding the campaign. 12 months None Yes, history of IDU, blood products before 1991, or elevated serum transaminase levels Yes Scr. uptake: NR NR NR

Prevalence: Intervention: 1.73% (276/15952; 95% CI: 1.53-1.94)

Comparison: 1.67% (231/13799; 95% CI:1.47-1.90)**

Outcomes: RNA rate: NR

Start treatment: NR

SVR: NR

Roudot-Thoraval et al. 2000 [78] 1997-1998 GP patients aged 6–85 years France (1.1%): Le Doubs and no 6 d’Ile-de-France GP clinics Intervention 1: GPs asked their patients for risk factors for HCV and offered screening to those at risk. Intervention 2: Posters and leaflets in GPs waiting rooms, motivating those with a risk to discuss testing with their GP. 15 months None Yes, several risk factors (not all are listed), among which a history of IDU, transfusion, tattoo, HCV in social environment Yes (intervention 2)

Scr. uptake: NR

Prevalence: Intervention 1: 5.7% (15/261; 95% CI: 3.51-9.26)

Intervention 2: 4.4% (10/228; 95% CI: 2.40-7.88)**

Listed risk factors:

- History of IDU

- Transfusion before 1991 - Elevated ALT or symptoms

- Tattoo

- Other

NR

Outcomes:

RNA rate: NR

Start treatment: NR

SVR:

Note: CI = confidence interval; NR = not reported; IDU = injecting drug use; HCV = hepatitis C virus; HBV = hepatitis B virus; HIV = human immunodeficiency virus; ALT = alanine aminotransferase; AST = aspartate aminotransferase; 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, 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).

aThese programs combined a nonintegrated screening approach with integrated screening at the GP clinic (see Additional file 1: Table S1). Here only results of the integrated screening are presented.

bMédecins du Monde (‘Doctors of the World’) is an international humanitarian organization providing medical care to vulnerable populations.

cTransfusion before 1991, history of drug use, history of gastroscopy, contact with HCV infected person (spouse or other family member, occupational exposure, active or former imprisonment, history of invasive procedures (catheterism, fluid aspiration/cytology, biopsy), history of colonoscopy, history of surgery.

Zuure et al.

Zuure et al. BMC Public Health 2014 14:66   doi:10.1186/1471-2458-14-66

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