TY - JOUR
T1 - Current state of and needs for hepatitis B screening
T2 - Results of a large screening study in a low-prevalent, metropolitan region
AU - Bottero, Julie
AU - Boyd, Anders
AU - Lemoine, Maud
AU - Carrat, Fabrice
AU - Gozlan, Joel
AU - Collignon, Anne
AU - Boo, Nicolas
AU - Dhotte, Philippe
AU - Varsat, Brigitte
AU - Muller, Gerard
AU - Cha, Olivier
AU - Valin, Nadia
AU - Nau, Jean
AU - Campa, Pauline
AU - Silbermann, Benjamin
AU - Bary, Marc
AU - Girard, Pierre-Marie
AU - Lacombe, Karine
PY - 2014/3/24
Y1 - 2014/3/24
N2 - 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. © 2014 Bottero et al.
AB - 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. © 2014 Bottero et al.
KW - Adult
KW - Centers for Disease Control and Prevention, U.S.
KW - Cities/epidemiology
KW - Female
KW - Health Services Needs and Demand/statistics & numerical data
KW - Hepatitis B Surface Antigens/blood
KW - Hepatitis B/blood
KW - Humans
KW - Male
KW - Mass Screening/statistics & numerical data
KW - Middle Aged
KW - Physicians
KW - Prevalence
KW - Risk Factors
KW - Surveys and Questionnaires
KW - United States
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84899718859&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/24663387
U2 - https://doi.org/10.1371/journal.pone.0092266
DO - https://doi.org/10.1371/journal.pone.0092266
M3 - Article
C2 - 24663387
SN - 1932-6203
VL - 9
SP - e92266
JO - PLOS ONE
JF - PLOS ONE
IS - 3
M1 - e92266
ER -