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Table 4 Integrated screening programs at VA clinics

From: Outcomes of hepatitis C screening programs targeted at risk groups hidden in the general population: a systematic review

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

Groom et al. 2008 [79]

2000-2001

Veterans

USA (1.9%): Minneapolis

Veteran Affairs clinic

2 years

None

Yes, only those with a risk factor were screened (risk factors not specified)

NR

Scr. uptake: NR

NR

In total, 520/681 were HCV RNA positive of which 430 referred to a specialist, of which 88.8% (382/430) attended an appointment. Of those, 32.5% (124/382) received treatment which was successful in 37.0% (46/124) (SVR).

Prevalence: 5.5% (681/12485; 95% CI: 5.1-5.9)*

Outcomes: RNA rate: 76.4% (520/681)

Start treatment: 32.5% (124/382)

SVR: 37.1% (46/124)

Mallette et al. 2008 [80]

1998-2004

Veterans

USA (1.9%): Providence

GP patients presenting to VA clinics

5 years and 8 months

None

Yes, only those with a risk factor were screeneda

NR

Scr. uptake: 66.7% (5646/8471)

Prevalence: 7.3% (412/5646; 95% CI: 6.6-8.0); without already known positives: 260/5646 = 4.6% (95% CI = 4.1-5.2%)***

Listed risk factors:

- History of IDU

- Blood transfusion before 1992

- Intranasal cocaine use

- Multiple sex partners

- Tattoos

Of the newly diagnosed, 46.9% (122/260) had chronic HCV, of which 46.7% (57/122) were treatment eligible. Of those, 31.6% (18/57) received treatment and 33.3% (6/18) reached an SVR.

Outcomes: RNA rate: 46.9% (122/260)

Start treatment: 14.8% (18/122)

SVR: 33.3% (6/18)

Cheung et al. 2006 [81]

2000-2001

Veterans

USA (1.9%): Palo Alto

VA clinic

12 months

None

Yes, if not previously tested, and if one or more risk factors were reportedb

NR

Scr. uptake: NR

NR

In total, 362/536 patients were evaluated of which 84.8% (307/362) had chronic HCV. Of those, 18.6% (57/307) were treatment eligible of whom 24.6% (14/57) completed treatment with long-term follow-up, and 35.7% (5/14) achieved SVR.

Prevalence: 5.0% (536/10751; 95% CI: 4.6-5.4)***

Outcomes: RNA rate: 84.8% (307/362)

Start treatment: NR

SVR: 35.7% (5/14)

Rifai et al. 2006 [82]

2000-2001

Veterans

USA (1.9%): Virginia

Rural VA clinic

22 months

None

Yes, only non-IDU substance using veterans who were admitted to a substance-use residential and rehabilitation treatment program were tested

NR

Scr. uptake: 99.4% (338/340)

Prevalence: 23.1% CHCV (78/338; 95% CI: 18.9-27.9) (incl. 2 who knew already)****

Univariate regr. analysis:

- Cocaine snorting

- History of IDU

In total, 48.7% (38/78) of the patients remained abstinent for 6 months and 30 were indicated for treatment and received treatment. In 46.7% (14/30) treatment was successful (SVR).

Outcomes: RNA rate: n/a

Start treatment: 81.1% (30/37)

SVR: 46.7% (14/30)

Zuniga et al. 2006 (abstract) [83]

2001-2003

Veterans

USA (1.9%): Suffolk County, Long Island

Primary-care outpatient departments of the Northport VA clinic (suburban VA hospital)

27 months

None

Yes, only those with a risk factor were screenedc

No

Scr. uptake: 41.9% (2263/5400)

Prevalence: 4.6% CHCV (103/2263; 95% CI: 3.8-5.5)****

Multivariable regr. analysis

- Age 40–54 yrs

- Black race

- History of IDU

- Service during Vietnam era

- Blood transfusion prior to 1992

- Tattoo or repeated body piercing

- History of abnormal LFTs

NR

Outcomes:

RNA rate: n/a

Start treatment: NR

SVR: NR

  1. Note: CI = confidence interval; NR = not reported; VA = veterans affairs; IDU = injecting drug use; HCV = hepatitis C virus; CHCV = chronic hepatitis C virus; HIV = human immunodeficiency virus; LFT = liver function test; SVR = sustained virological response; PCR = polymerase chain reaction.
  2. *HCV-antibody prevalence is considered suboptimal (data were collected before 1994 when sensitivity/specificity of tests was not optimal, or reactive HCV-antibody test results were not confirmed by immunoblot).
  3. ***HCV-antibody prevalence is considered valid; data were collected after 1993, and reactive HCV-antibody test results were confirmed by second or higher generation immunoblot assays from Ortho, Chiron, Novartis (RIBA), Innogenetics (LiaTek), Pasteur (DECISCAN HCV), Genelabs Diagnostics (HCV BLOT), or Mikrogen (recomBlot HCV IgG 2.0).
  4. ****HCV-antibody prevalence is considered valid, but reflecting chronic HCV infection (data were collected after 1993, and reactive HCV antibody test results were confirmed by PCR).
  5. aVietnam-era veteran, transfusion of blood of blood products before 1992, history of IDU, history of snorting cocaine, history of 5 or more drinks a day for 10 or more years in your lifetime, history of multiple (10 or more) sexual partners in your lifetime, a man who has sex with men, history of exposure to blood on skin or mucous membranes, required chronic hemodialysis, have a tattoo or body piercing, have had a positive test for HIV or hepatitis B, have been told that you have unexplained liver disease.
  6. bBlood transfusion prior to 1992, IV drug use (even once), snorting of cocaine, blood exposure, sexual promiscuity (>10 lifetime sex partners), renal dialysis, tattoo or body piercing, excessive alcohol use.
  7. cVietnam-era veteran, transfusion of blood products prior to 1992, history of IDU, blood exposure in or through skin or mucous membranes, multiple sexual partners (past or present), hemodialysis, tattoo or repeated body piercing, intranasal cocaine use (past or present), unexplained liver disease, having been told that he/she has abnormal liver function tests, intemperate alcohol use (more than seven alcoholic beverages per week).
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BMC Public Health

ISSN: 1471-2458

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