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Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia:
Emilie Mosnier1,2, Olivier Ségéral2,3, Sansothy Neth2
1Aix Marseille Université, Institut national de la santé et de la recherche médicale (INSERM), Institut de recherche pour le développementIRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM) Aix Marseille Univ,, Aix Marseille Institute of Public Health (ISSPAM), Marseille, France.
Background:
In Cambodia, hepatitis C constitutes a significant public health challenge, particularly among older adults (>45 years) for whom prevalence is estimated to be 5%. To facilitate the elimination of hepatitis C among the general population, enhancing access to screening and treatment is imperative. In this regard, the evaluation of community-based screening programs emerges as a crucial step toward improving health care accessibility.
Objective:
This study aims to assess the comparative efficacy of a community-based versus a facility-based approach in enhancing the uptake of hepatitis C antibody testing among the general population older than 40 years of age in Cambodia.
Methods:
The CAM-C (Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia) study uses a cluster-randomized controlled trial design across two Cambodian provinces to compare community-based and facility-based hepatitis testing interventions. Sampling involves a multistage cluster approach, targeting individuals older than 40 years of age due to their higher prevalence and risk of chronic hepatitis complications. This study incorporates a qualitative analysis of acceptability and a cost-effectiveness comparison. Interventions include facility-based testing with subsequent referral and community-based testing with direct in-home assessments. Follow-up for positive cases involves comprehensive management and potential direct-acting antiviral treatment. This study aims to identify a significant increase in testing uptake, requiring the screening of 6000 individuals older than 40 years of age, facilitated by a structured sampling and intervention approach to minimize contamination risks.
Results:
The final protocol including the quantitative, qualitative, and cost-effectiveness part of the study was registered and was approved in 2019 by the National Ethical Cambodian for Health Research. Inclusions were completed by mid-2024, with analyses starting in May 2024.
Conclusions:
Using a mixed methods approach that combines a robust methodology (cluster-randomized controlled trial) with a cost-effectiveness analysis and qualitative research, such a study should provide invaluable information to guide the Ministry of Health in its hepatitis C virus screening strategy and move toward elimination.
Trial Registration:
ClinicalTrials.gov NCT03992313; https://clinicaltrials.gov/study/NCT03992313.
International Registered Report Identifier (Irrid):
DERR1-10.2196/63376.
