Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
J Formos Med Assoc. 2022 Sep;121(9):1850-1856. doi: 10.1016/j.jfma.2022.03.004. Epub 2022 Mar 24.
Hyperendemic townships of hepatitis C virus (HCV) infection should devote extra efforts to eliminate HCV. We aimed to evaluate efficacy of the screening and linkage to care in two HCV hyperendemic townships.
Village-to-village HCV screening using anti-HCV reflex HCV Ag test was conducted in two HCV hyperendemic rural townships (Lioujiao and Yijhu). All residents aged 30 years or older were invited. Those patients detected as infected were referred to nearby hospitals or clinics in Lioujiao and to an accessible outreach hepatology clinic in Yijhu.
The populations of Lioujiao and Yijhu townships at time of survey were 18,389 and 14,787 with 6086 (33.1%) and 4604 (31.1%) having ever been previously screened, and 1517 and 1071 responded to this screening respectively. Their crude screening coverage rates were 41.5% and 38.5%, and adjusted screening coverage rates were 54.3% and 94.6% respectively. The prevalence rates of anti-HCV and HCV Ag were 17.9% and 11.9% in Lioujiao, and 9.2% and 5.6% in Yijhu respectively, with their rates of antigenemia (HCV Ag/anti-HCV) being 62.1% and 60.6% respectively. Numbers needed to test (NNT) to find a candidate for anti-viral treatment were 9 and 18. For linkage to care, treatment rate by referral (Lioujiao) was slightly lower than by accessible outreach hepatology clinic (Yijhu) (84.9% vs. 93.3%, p = 0.093). Overall successful sustained virological response rate at week 12 was 98.2% (161/164) in outreach hepatology clinic.
Since NNT was low, it was worthwhile conducting intensive screening in these hyperendemic townships. For high treatment rate, accessible outreach hepatology clinic is feasible especially in areas without adequate medical resources.
丙型肝炎病毒（HCV）感染的高度流行乡镇应加大力度消除 HCV。本研究旨在评估在两个 HCV 高度流行的乡镇进行筛查和联系护理的效果。
在两个 HCV 高度流行的农村乡镇（六脚和义湖）进行逐村 HCV 筛查，邀请所有 30 岁或以上的居民参加。检测到感染的患者被转介到六脚的附近医院或诊所，以及义湖的可及性外展肝病诊所。
调查时，六脚和义湖两个乡镇的人口分别为 18389 人和 14787 人，其中分别有 6086（33.1%）人和 4604（31.1%）人以前接受过筛查，分别有 1517 人和 1071 人对本次筛查做出了回应。他们的粗筛查覆盖率分别为 41.5%和 38.5%，调整后的筛查覆盖率分别为 54.3%和 94.6%。六脚的抗 HCV 和 HCV Ag 的流行率分别为 17.9%和 11.9%，义湖分别为 9.2%和 5.6%，其抗原血症（HCV Ag/抗-HCV）率分别为 62.1%和 60.6%。发现抗病毒治疗候选者所需的检测数量（NNT）分别为 9 和 18。对于联系护理，转介（六脚）的治疗率略低于可及性外展肝病诊所（义湖）（84.9%对 93.3%，p=0.093）。外展肝病诊所的总体持续病毒学应答率在第 12 周为 98.2%（161/164）。
由于 NNT 较低，在这些高度流行的乡镇进行密集筛查是值得的。为了获得高的治疗率，可及性外展肝病诊所是可行的，特别是在医疗资源不足的地区。
