在一个低流行国家，使用即时检验进行机会性筛查可成功促使感染乙肝病毒的移民人群接受治疗。
Opportunistic screening using point-of-care testing leads to successful linkage to care of HBV-infected migrant populations in a low endemic country.
作者信息
Ho Erwin, Vanderlinden Axelle, Govaerts Liesbeth, De Fooz Bo, Van Damme Pierre, Michielsen Peter, Vanwolleghem Thomas
机构信息
University of Antwerp, Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Paediatrics, Antwerpen, Belgium.
Antwerp University Hospital, Department of Gastroenterology and Hepatology, Edegem, Belgium.
出版信息
J Virus Erad. 2024 Mar 27;10(1):100369. doi: 10.1016/j.jve.2024.100369. eCollection 2024 Mar.
BACKGROUND AND AIMS
In low endemic countries, screening for hepatitis B surface antigen (HBsAg) in migrants is cost-effective in reducing the disease burden of hepatitis B virus (HBV) infections, but linkage to care (LTC) remains a challenge. This study aims to guide future screening initiatives, with 3 objectives: 1. to compare LTC between different ethnic groups screened for HBsAg with point-of-care testing (POCT) in an outreach setting; 2. to estimate the proportion of HBsAg seropositivity for ethnic minorities; and 3. to investigate the association between seropositivity and HBV risk factors.
METHODS
Opportunistic outreach screenings using finger prick HBsAg tests were performed at civic integration programmes between 11/2017 and 09/2022. If an individual tested positive, an appointment was given immediately at the outpatient hepatology clinic for follow-up and confirmation of HBsAg positivity in blood. Dedicated personnel contacted these individuals to motivate them for further LTC, which was defined as being assessed by a hepatologist, a blood test and an abdominal ultrasound.
RESULTS
A total of 677 people from different ethnicities (Asian, Middle Eastern and African) were serologically screened using POCT. The observed positivity for HBsAg was 3.4 % (95% CI 2.17-5.05, 23/677). Apart from ethnicity and male sex, none of the surveyed HBV risk factors were associated with HBsAg seropositivity. All HBsAg positive individuals were linked to care and assessed by a hepatologist, despite the COVID-19 pandemic increase in time to follow-up of 82 days (95% CI 51-112 days) vs. 24 days (95% CI 5-43 days, p = 0.008)).Among HBV-infected patients, 31.8% (7/22), 100 % (22/22) and 26.1% (6/23) met the criteria for treatment indication, intrafamilial transmission risk and need for hepatocellular carcinoma surveillance, respectively.
CONCLUSION
The proportion of HBsAg seropositivity in ethnic minorities was 3.4%. POCT and commitment of dedicated personnel can overcome previously identified barriers resulting in a 100% LTC.
背景与目的
在乙肝低流行国家，对移民进行乙肝表面抗原（HBsAg）筛查在减轻乙肝病毒（HBV）感染疾病负担方面具有成本效益，但与医疗服务的衔接（LTC）仍然是一项挑战。本研究旨在指导未来的筛查工作，有3个目标：1. 比较在社区外展环境中通过即时检测（POCT）进行HBsAg筛查的不同种族群体之间的LTC情况；2. 估计少数民族中HBsAg血清阳性率；3. 调查血清阳性与HBV危险因素之间的关联。
方法
在2017年11月至2022年9月期间的公民融合项目中，采用手指针刺HBsAg检测进行机会性外展筛查。如果个体检测呈阳性，会立即安排在门诊肝病诊所进行随访，并确认血液中HBsAg阳性。专门人员联系这些个体，激励他们接受进一步的LTC，LTC定义为由肝病专家进行评估、血液检测和腹部超声检查。
结果
共对677名来自不同种族（亚洲、中东和非洲）的人进行了POCT血清学筛查。观察到的HBsAg阳性率为3.4%（95%CI 2.17 - 5.05，23/677）。除了种族和男性性别外，所调查的HBV危险因素均与HBsAg血清阳性无关。尽管在新冠疫情期间随访时间增加到82天（95%CI 51 - 112天），而之前为24天（95%CI 5 - 43天，p = 0.008），但所有HBsAg阳性个体均与医疗服务衔接并由肝病专家进行了评估。在HBV感染患者中，分别有31.8%（7/22）、100%（22/22）和26.1%（6/23）符合治疗指征、家庭内传播风险和肝细胞癌监测的标准。
结论
少数民族中HBsAg血清阳性率为3.4%。POCT和专门人员的投入可以克服先前发现的障碍，实现100%的LTC。
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