Table 2 Integrated screening programs at clinics for sexually transmitted diseases (STD)
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 | Prescreening 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 |
D'Souza et al. 2003 [59] | 2001 | STD clinic clients | USA (1.9%): Houston | STD clinic | 9 months | STD | Yes, risk assessment questionnaire. screening offered to high-risk groups a | NR | Scr. uptake: 95.8% (822/859) Prevalence: 15.3% (126/822; 95% CI:12.7-17.7)* | Multivariable regr. analysis: - History of IDU - Age ≥25 yrs - Heroin use - Non-transfusion/ transplantation blood exposure - Shared straw to snort drugs | Patients were referred to appropriate settings for follow-up (no results were reported). Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
Scott et al. 2010 [60] | 2007 | STD clinic clients | UK (1.1%): London, Chelsea and Westminister hospital | STD clinic in hospital | 6Â months | STD | Yes, MSM | NR | Scr. uptake: 68.6% (2309/3365) Prevalence: 0.6% (15/2309; 95% CI:0.4-1.1%)** | Listed risk factors: - HIV+ - History of IDU - Unprotected anal intercourse | HCV RNA was tested in 13/15 HCV antibody positive persons. Outcomes: RNA rate: 69.2% (9/13) Start treatment: NR SVR: NR |
Weisbord et al. 2003 [61] | 2001 | STD clinic clients | USA (1.9%): Miami | STD clinic | 3 months | HAV, HBV | No | NR | Scr. uptake: 50.3% (687/1365) Prevalence: 4.7% (32/687; 95% CI: 3.3-6.5)*** | Multivariable regr. analysis: - History of IDU - Sex with HCV + person - Spent ≥ 1 day in prison - Older age | Patients received their test results within two weeks (no further results reported). Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
Gunn et al. 2003 [62] | 1999-2000 | STD clinic clients | USA (1.9%): San Diego | STD clinic | 8 months | STD | No | No | Scr. uptake: NR Prevalence: 4.9% (165/3367; 95% CI: 4.2-5.7)*** | Multivariable regr. analysis: - History of IDU - Age ≥30 yrs - Ever in jail - Blood transfusion before 1992 - History of bacterial STD - IDU sex partner | Post-test counseling was offered. A list of medical care resources was provided. In total, 136/165 were interviewed of whom 44% had no medical insurance, but 87% planned to have a medical evaluation. |
Outcomes: RNA rate: NR Start treatment: NR SVR: NR | |||||||||||
Mapagu et al. 2008 [63] | 2000-2002 | STD clinic clients | Australia (2%): Canberra | STD clinic | 3Â years | STD, BBV | No | NR | Scr. uptake: 46.0% (3113/6774) Prevalence: 3.1% (95/3113; 95% CI: 2.5-3.7%)** | Listed risk factors: - History of IDU - Tatoos - Body piercings - Blood transfusion - IDU partner - Needle stick - Mother HCV+ - Medical treatment overseas in childhood - Prison | Of the 95 HCV antibody positive persons, 47 were tested for HCV RNA. Outcomes: RNA rate: 61.7% (29/47) Start treatment: NR SVR: NR |
Zimmerman et al. 2007 [64] | 2001-2005 | STD clinic clients | USA (1.9%): Illinois excluding Chicago | STD clinics | 5Â years | HBV (only 2001), STD | Yes: 2001: IDU and snorting drugs were criteria. From 2002: only IDU | NR | Scr. uptake: NR | Listed risk factors: - Mainly IDU | Because of inadequate resources, the referrals and follow-up were not monitored. |
Prevalence: 21.2% (646/3042; 95% CI: 19.8-22.7)*** | Â | ||||||||||
Outcomes: RNA rate: NR Start treatment: NR SVR: NR | |||||||||||
Subiadur et al. 2007 [65] | 2000-2005 | STD clinic clients | USA (1.9%): Denver | STD clinics | 6Â years | STD, HIV | Yes: IDU, HCV-infected sex partner, blood transfusion before 1992 | NR | Scr. uptake: NR | NR | Patients were referred to a specialist but a sub-study of 65/467 clients showed that <20% followed through with recommended services. |
Prevalence: 28.0%. (467/1666; 95% CI: 25.9-30.2)** | |||||||||||
Outcomes: RNA rate: NR Start treatment: NR SVR: NR | |||||||||||
Heseltine & McFarlane 2007 [66] | 2000-2005 | Not specified; clients of the various settings | USA (1.9%): Texas | Several HIV/STD service providers: HIV counseling and testing sites; drug treatment facilities, corrections facilities, field visit/outreach sites (e.g., bars, adult bookstores, homeless shelters), STD clinics, family planning clinic, primary health care facility | 6Â years | STD, HIV | Yes: IDU, sharing equipment used to snort drugs; having received a tattoo or piercing under unsanitary conditions; having 50 or more lifetime sex partners; exchanging sex for money; having sex with an HCV-positive person; people with some medical exposures and occupations | No | Scr. uptake: NR Prevalence: 23.2% (8964/38717; 95% CI: 22.7-23.6)*** | Listed risk factors: - History of IDU (main risk factor) - Risky tattoo/piercing - Risky sex - Blood or medical exposure - Sharing snorting equipment - Occupational exposure | Post-test counseling and referral to public and private providers in the local community was offered. 50.3% of 776 substance abuse referrals, 22.4% of 4410 medical evaluation referrals, and 17.4% of 2299 vaccination referrals were confirmed. Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
Gunn et al. 2001 [67] | 1998 | STD clinic clients | USA (1.9%): San Diego | STD clinic | 6 weeks | HBV | No | No | Scr. uptake: 82.4% (618/750) Prevalence: 3.4% (21/618; 95% CI: 2.2-5.1)** | Listed risk factors: - History of IDU - Among non-IDU: age ≥30 yrs | HCV-positive persons were given information about the prevention of HCV transmission and a list of facilities where they might obtain a medical evaluation. Appr. 8 months after the project, 14/21 clients were contacted of whom 6 had seen a physician for medical evaluation. |
Outcomes: RNA rate: NR Start treatment: NR SVR: NR | |||||||||||
Ellks 2010 [68] | 2008 | Visitors of sexual and reproductive health service | UK (1.1%): Crewe | STD and reproductive Health Service (integrated service) | 1Â year | HIV, syphilis, HBV | No | No | Scr. uptake: NR Prevalence: 0.1% (8/5468; 95% CI: 0.1-0.3)** | Listed risk factors: - History of IDU - MSM who snorted drugs | There were follow-up appointments for those who tested positive. Outcomes: RNA rate: NR Start treatment: NR SVR: NR |
Tweed et al. 2010 [69] | 2002-2007 | Visitors of STD and contraception and sexual health clinics, and specialist HIV services | UK (1.1%): Throughout the country | STD clinics, contraception and sexual health clinics, specialist HIV services | 6Â years | Likely STD/HIV | No | NR | Scr. uptake: estimated at 14.0% Prevalence: 3.2% (285 8/90424; 95% CI: 3.04-3.27)** | Multivariable regr. analysis: - Male sex - Age 35+ - History of IDU | Those who tested positive were followed-up with clinicians (no data reported). |
| Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Of the antiHCV positive individuals, 60.1% (1719/2858) were tested for HCV RNA. |
| Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Outcomes: RNA rate: 69.2% (1191/1719) Start treatment: NR SVR: NR |