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

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

Clinical Hepatology

Vincent Wai-Sun Wong^1,2, Grace Lai-Hung Wong^1,2, Angel Mei-Ling Chim^1,2, Tsz-Fai Cheng², Shirley Wing-Yan Cheung², Carol Man-Sze Lai², Kylie Joan-Yi Szeto², Sharon Tsang², Stephen Ho-Chun Wu², Kenneth Kar-Lung Yan³, Alex Yui Hui³, Desmond Chi-Him Yiu³, Brian Bing-Ying Wu³, David Cheung⁴, Cedric Sze-Lai Chung⁴, Camey Wai-Man Lai^1,2, Henry Lik-Yuen Chan^1,2,*

DOI: 10.1111/jgh.12355

This article is protected by copyright. All rights reserved.

Abbreviations:HCC, hepatocellular carcinoma; HCV, hepatitis C virus; IDU, injection drug user; IQR, interquartile range; SD, standard deviation

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jgh.12355

Keywords: Liver cirrhosis; interferons; elasticity; opioid-related disorders; patient compliance

Abstract

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. 130 (56%) subjects were anti-HCV positive. The number needed to screen to detect 1 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.

Source