Opportunistic Screening for Hepatitis B and C in Primary Care Using a Reflex Testing System: A Microelimination Model

Area of Science:

• Hepatology
• Infectious Diseases
• Public Health

Background:

• Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major global health challenges.
• Current World Health Organization (WHO) 2030 elimination targets necessitate improved detection beyond risk-based screening.
• Primary care settings offer a potential venue for enhanced viral hepatitis detection.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of an automated opportunistic screening program for HBV and HCV in Primary Care.
• To assess the diagnostic yield and patient referral pathway for positive cases.
• To determine the contribution of this strategy to viral hepatitis elimination efforts.

Main Methods:

• A prospective study involving universal screening for HBsAg and anti-HCV in adults attending a Primary Care center in Barcelona.
• Inclusion criteria: adults requiring a blood test for any reason between February 2023 and February 2025.
• Positive cases were automatically referred to the Hepatology Department for further management.

Main Results:

• 3,103 individuals were screened, revealing anti-HCV positivity of 2.0% (0.35% active infection) and HBsAg prevalence of 0.8%.
• 82% of viremic HCV patients and 17% of HBsAg-positive individuals initiated antiviral treatment.
• A significant proportion of infected individuals (45% HCV RNA, 44% HBsAg) lacked recognized risk factors or elevated ALT levels, highlighting limitations of traditional screening.

Conclusions:

• Automated opportunistic screening in Primary Care is a feasible and effective strategy for identifying HBV and HCV infections.
• This integrated approach successfully detects infections often missed by risk factor-based screening.
• The program shows promise for contributing significantly to the micro-elimination of viral hepatitis.