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PLoS One. 2014 Mar 24;9(3):e92266. doi: 10.1371/journal.pone.0092266. eCollection 2014.

Current state of and needs for hepatitis B screening: results of a large screening study in a low-prevalent, metropolitan region.

Author information

1
Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
2
Inserm UMR-S707, Paris, France.
3
Service d'Hépatologie, Hôpital St Antoine, AP-HP, Paris, France.
4
Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Unité de Santé Publique, Hôpital St Antoine, AP-HP, Paris, France.
5
Laboratoire de Virologie, Hôpital St Antoine, AP-HP, Paris, France.
6
Laboratoire St Marcel, Mairie de Paris, Paris, France.
7
Direction de l'Action Sociale, de l'Enfance et de la Santé, Mairie de Paris, Paris, France.
8
Centre de dépistage anonyme et gratuit (CDAG) du Figuier, Mairie de Paris, Paris, France.
9
Département des Examens Périodiques de Santé (DEPS), CPAM de Paris, France.
10
CDAG de Belleville, Paris, France.
11
Policlinique Baudelaire, Hôpital St Antoine, AP-HP, Paris, France.
12
Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
13
Centre d'accueil, de soins et d'orientation, Médecins du Monde, Paris, France.
14
Unité de consultation et de soins ambulatoires (UCSA), Maison d'arrêt de la santé, Paris, France.
15
Centre Croix Rouge du Moulin Joly, Paris, France.

Abstract

BACKGROUND:

In low hepatitis B virus (HBV)-prevalent countries, most HBV-infected persons are unaware of their status. We aimed to evaluate whether (i) previous HBV-testing, (ii) physicians decision to screen, and (iii) CDC's recommendations identified infected individuals and which risk-factor groups needing testing.

METHODS:

During a mass, multi-center HBV-screening study from September 2010-August 2011, 3929 participants were screened for hepatitis B surface antigen (HBsAg), anti-HBs and anti-Hepatitis B core antibodies (anti-HBcAb). Questions on HBV risk-factors and testing practices were asked to participants, while participants' eligibility for HBV-testing was asked to study medical professionals.

RESULTS:

85 (2.2%) participants were HBsAg-positive, while 659 (16.8%) had either resolved HBV infection or isolated anti-HBcAb. When comparing practices, HBV-testing was more likely to occur in HBV-infected participants if Centers for Disease Control and Prevention (CDC) recommendations were used (Sensitivity = 100%, 95%CI: 95.8-100) than physicians' discretion (Sensitivity = 87.1%, 95%CI: 78.0-93.4) or previous HBV-test (Sensitivity = 36.5%, 95%CI: 26.3-47.6) (p<0.0001). Nevertheless, many non-infected individuals would still have been screened using CDC-recommendations (Specificity = 31.1%, 95%CI: 29.6-32.6). Using multivariable logistic regression, HBsAg-positive status was significantly associated with the following: males, originating from high HBV-endemic region, contact with HBV-infected individual, without national healthcare, and intravenous-drug user (IDU). Of these risk-factors, physician's discretion for testing HBV was not significantly associated with participants' geographical origin or IDU.

CONCLUSIONS:

Missed opportunities of HBV-screening are largely due to underestimating country of origin as a risk-factor. Applying CDC-recommendations could improve HBV-screening, but with the disadvantage of many tests. Further development of HBV-testing strategies is necessary, especially before severe disease occurs.

PMID:
24663387
PMCID:
PMC3963888
DOI:
10.1371/journal.pone.0092266
[Indexed for MEDLINE]
Free PMC Article

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