Targeted hepatitis C screening among ex-injection drug users in the community
- Conflict of interest: Vincent Wong has been a consultant for Merck and Otsuka and served in the advisory board of Gilead. Grace Wong has served in the advisory boards of Otsuka and Gilead, and received paid lecture fees from Echosens, Bristol-Myers Squibb, Furui and Otsuka. Henry Chan has been a consultant for Abbott, Bristol-Myers Squibb, Furui, Gilead, Merck, Novartis, and Roche, and has received paid lecture fees from Abbott, Bristol-Myers Squibb, Echosens, Gilead, Glaxo-Smith-Kline, Merck, Novartis, and Roche. The other authors reported no potential conflict of interest.
Background and Aim
Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. It is highly prevalent among injection drug users (IDUs) but is often undiagnosed because they represent an underprivileged group that faces multiple barriers to medical care. Here, we report the results of the New Life New Liver Project, which provides targeted HCV screening and education for ex-IDUs in the community.
Patients were recruited through the social worker networks and referrals by fellow ex-IDUs, and rapid diagnosis was based on point-of-care anti-HCV testing at rehabilitation centers.
From 2009 to 2012, we served 234 subjects. One hundred thirty (56%) subjects were anti-HCV positive. The number needed to screen to detect one patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6–2.0). However, only 69 (53%) HCV patients attended subsequent follow-up at regional hospitals, and 26 (20%) received antiviral therapy. Patients who attended follow-up were older, had higher education level and more active disease as evidenced by higher alanine aminotransferase, HCV RNA, and liver stiffness measurement by transient elastography.
Targeted screening in ex-IDUs is effective in identifying patients with HCV infection in the community. Improvement in the referral system and introduction of interferon-free regimens are needed to increase treatment uptake.