Targeted hepatitis C screening among ex-injection drug users in the community

• Published in: Journal of gastroenterology and hepatology Vol. 29; no. 1; pp. 116 - 120
• Main Authors: Wong, Vincent Wai-Sun, Wong, Grace Lai-Hung, Chim, Angel Mei-Ling, Cheng, Tsz-Fai, Cheung, Shirley Wing-Yan, Lai, Carol Man-Sze, Szeto, Kylie Joan-Yi, Tsang, Sharon, Wu, Stephen Ho-Chun, Yan, Kenneth Kar-Lung, Hui, Alex Yui, Yiu, Desmond Chi-Him, Wu, Brian Bing-Ying, Cheung, David, Chung, Cedric Sze-Lai, Lai, Camey Wai-Man, Chan, Henry Lik-Yuen
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.01.2014
• Subjects: Alanine Transaminase; Biomarkers; Community Health Services; Community Networks; Drug Users - statistics & numerical data; elasticity; Elasticity Imaging Techniques; Female; Follow-Up Studies; Hepacivirus - genetics; Hepacivirus - immunology; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C - prevention & control; Hepatitis C virus; Hong Kong - epidemiology; Humans; interferons; liver cirrhosis; Male; Mass Screening - methods; Middle Aged; opioid-related disorders; patient compliance; Patient Education as Topic; Point-of-Care Systems; RNA, Viral; Severity of Illness Index; Hong Kong; patient compliance; interferons; opioid-related disorders; elasticity; liver cirrhosis
• DOI: 10.1111/jgh.12355
• ISSN: 0815-9319

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. Methods 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. Results 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. Conclusions 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.