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[Strategies of hepatitis C screening in general practice. Results of a two-center randomized trial]
F Roudot-Thoraval1, E Monnet, P Mercet
1Service de Santé Publique, Hôpital Henri-Mondor, Créteil.
Insights
Improving hepatitis C virus (HCV) detection in general practice yielded a 5% positive diagnosis rate, irrespective of the screening strategy. This highlights the need for enhanced screening procedures due to low identified risk factors.
Area of Science:
- Hepatology
- Infectious Diseases
- General Medicine
Background:
- Hepatitis C virus (HCV) infection remains a significant public health concern.
- Effective screening strategies are crucial for early detection and treatment of HCV.
- General practice settings offer a potential venue for widespread HCV screening.
Purpose of the Study:
- To compare two distinct screening strategies for hepatitis C virus infection detection in general medicine.
- To evaluate the effectiveness of practitioner-led risk factor identification versus informational materials in promoting HCV testing.
Main Methods:
- A comparative study involving 184 general practitioners across two networks.
- Practitioners were randomized into two groups: one identifying risk factors through patient questioning, the other using waiting room informational materials.
- HCV serologies were prescribed, performed, and analyzed over a 15-month period.
Main Results:
- No significant difference in the number of prescribed, performed, or positive HCV serologies between the two groups.
- A total of 489 serologies were performed, with 25 (5.1%) testing positive for HCV.
- Common risk factors identified included drug use (44%) and history of transfusion (16%) among positive cases.
Conclusions:
- Both screening strategies resulted in a similar 5% rate of diagnosed HCV infections.
- The low number of serologies prescribed suggests challenges in identifying at-risk patients in general practice.
- Alternative and potentially more effective screening procedures for hepatitis C virus require further investigation and evaluation.
Objectives:
To improve the detection of patients infected with hepatitis C virus.
Methods:
A study was undertaken in the general medicine setting in two hepatitis C networks. General practitioners volunteered and received training on hepatitis C, then were randomly assigned to one of two screening strategies: group 1: general practitioners prescribed hepatitis C virus testing if the risk factors for HCV hepatitis C virus infection were identified during questioning of patients, group 2: general practitioners were helped in their screening approach by posters and leaflets on the risk factors of hepatitis C virus, available in the waiting room.
Results:
A total of 184 general practitioners enrolled 90 from group 1 and 94 from group 2. During a 15-month-period, 617 serologies were prescribed, 323 by general practitioners in group 1 (in patients who were an average of 40 year-old) and 294 in group 2 (in patients who were an average of 44 year-old); 489 serologies (79.3%) were actually performed (261 and 228 respectively) and 25 (5.1%) tested positive (15 and 10 respectively). The number of prescribed, performed, and positive serologies did not differ from one group to the other. The motive for hepatitis C virus screening was similar in both groups and included a history of transfusion in 27% of cases, intravenous drug use in 6%, increased ALT or symptoms compatible with hepatitis in 13%, nosocomial exposure in 22%. Risk factors in the 25 patients who were hepatitis C virus positive were drug use (44%), history of transfusion before 1991 (16%), elevated ALT or symptoms (12%), others (28%).
Conclusion:
This study comparing screening strategies in general medicine, resulted in the diagnosis of hepatitis C virus infection in 5% of tested patients, regardless of the strategy. However, the fewer serologies prescribed by general practitioners (an average of 3 tests in a 15-month-period) suggests a low rate of identified risk factors in general practice, and emphasizes that other types of screening procedures should be implemented and evaluated.
