Sahajian F, Vanhems P, Bailly F, Fabry J, Trepo C, Sepetjan M
Programme ADHEC, Laboratoire d'Epidémiologie et de Santé Publique Université de Lyon, France.
Eur J Public Health. 2007 Jun;17(3):263-71. doi: 10.1093/eurpub/ckl233. Epub 2006 Oct 26.
A screening campaign for hepatitis C virus (HCV) infection was carried out in eight health centres of Lyon from June 2003 until March 2004. The population targeted for screening was underprivileged individuals without any social insurance, protected by Couverture Mutuelle Universelle or Aide Médicale Etat (AME), to estimate the prevalence of anti-HCV antibodies in this population and to identify associated risk factors.
After training in HCV infection and screening, 43 general practitioners participated in the campaign. Information about patient socio-demographics and risk factors was collected prior to proposing screening serology. Blood samples were often taken in health centres. Follow-up of positive cases was organised via the Reference Centre of HCV Infection in Lyon with possible specialised consultations in health centres.
The average age of the 988 individuals in the campaign was 37 years; 51% were women; 54% had a foreign nationality; 21% lived in sheltered accommodation; 19% were lodged in third-party accommodation; 9% were homeless; and 57% possessed less than euro562 (Revenu Minimum d'Insertion level). Screening was not proposed to nine patients because of medico-psychological problems. The acceptance rate for screening was 98.8% (967/979), and testing was carried out on 97.6% of these subjects (944/967). The prevalence of anti-HCV antibodies in the sample was 4.7% (44/944) (95% CI = 3.4-6.2). Nearly 80% of positive cases were unknown prior to the campaign. Multivariate logistic regression modelling identified lifetime injection drug use [odds ratios (OR) = 15.99; P < 0.0001], lifetime medical care in a foreign country (OR = 4.46; P = 0.001), and wearing tattoos (OR = 2.75; P = 0.048) as significant risk factors for carrying anti-HCV antibodies. Characteristics independently associated with HCV seropositivity were age between 40 and 49 years, AME benefits, and no social insurance.
Wide acceptance of screening, high prevalence of anti-HCV antibodies (much higher than in the French population in general), a high proportion of positive cases unknown beforehand, and satisfactory follow-up of seropositive patients are all factors which support the need for a screening campaign targeting HCV infection in underprivileged persons living in France.
2003年6月至2004年3月期间，在里昂的八个健康中心开展了丙型肝炎病毒（HCV）感染筛查活动。筛查目标人群为没有任何社会保险、受全民互助保险或国家医疗救助（AME）保护的弱势群体，以评估该人群中抗-HCV抗体的流行率并确定相关危险因素。
43名全科医生在接受HCV感染及筛查培训后参与了此次活动。在建议进行筛查血清学检测之前，收集了患者的社会人口统计学信息和危险因素信息。血样通常在健康中心采集。通过里昂HCV感染参考中心组织对阳性病例进行随访，并在健康中心进行可能的专科会诊。
此次活动中988名个体的平均年龄为37岁；51%为女性；54%为外国国籍；21%居住在收容所；19%住在第三方提供的住所；9%无家可归；57%的人收入低于562欧元（最低融入收入水平）。因医学心理问题未对9名患者建议进行筛查。筛查的接受率为98.8%（967/979），其中97.6%的受试者（944/967）进行了检测。样本中抗-HCV抗体的流行率为4.7%（44/944）（95%置信区间=3.4-6.2）。近80%的阳性病例在活动前未知。多因素逻辑回归模型确定，终生注射吸毒[比值比（OR）=15.99；P<0.0001]、在国外接受终生医疗护理（OR=4.46；P=)=0.001）和纹身（OR=2.=75；P=0.048）是携带抗-HCV抗体的重要危险因素。与HCV血清学阳性独立相关的特征为年龄在40至49岁之间、享受AME福利且无社会保险。
筛查的广泛接受度、抗-HCV抗体的高流行率（远高于法国总体人群）、高比例的事先未知阳性病例以及对血清学阳性患者的满意随访，所有这些因素都支持有必要针对居住在法国的弱势群体开展HCV感染筛查活动。
