ABSTRACT
Background and aims: Universal screening appears to be the most cost-effective strategy to reach the HCV elimination planned byWHO for 2030. All HCV patients have currently access to treatment. In France HCV screening is based on identification of Risk Factor. The aim of the present studywas to test universal screening strategy in all hospitalized patients. Method: From November 2019 to November 2021, we conduct a prospective, longitudinal monocentric study screening all consent patients for HCV regardless identification of Risk Factor. All HCV Ab positive was followed by HCV RNA screening. All replicating patients were proposed to be treated according to the other pathologies for which the patients were hospitalized. The study was authorized by CPP Toulouse. Because of occurrence COVID 19 pandemics, conducting this studywe identify several limitations leading to the prolongation of inclusion time and to develop adaptive measures such as oral consent. Results: As of September 30, 2021 results are shown in this figure: (Figure Presented) HCV Ab + patients seemed older;however this difference is not statistically different. Large part of patients (2/3) were unware of the HCV status. 49 (39.5%) patients come from surgical departments, 38 (30.5%) from the medical department and 37 (30%) are followed in gastroenterology office. All HCV RNA+ patients have been evaluated for treatment. 8 are eradicated, 2 DAA therapy are still on going,1patient refuse treatment (89 years old), 5 patients suffer from HCC and treatmentwas delayed, 2 patients died during palliative management Conclusion: HCVAb prevalence recorded is significantly higher than that observed in the general population in France. However only 15.8% of hospitalized patients have been included. Motivation of all health care workers is essential. Final results of the study will be present at the meeting
ABSTRACT
Background: France is currently on track to meet the Who hepatitis C virus elimination. Universal screening appears to be the most cost-effective strategy to reach this goal. Since May 2019, all HCV patients have access to treatment. Up to now, strategy of HCV screening is based on HAS Recommendations of March 2019 targeting patients with risk factors. The aim of the present study was to test universal screening strategy in all patients in our hospital. Methods: From November 2019 to November 2021 we conduct a monocentric, prospective, study (DEVICHO) to propose screening at entry for all hospitalized patients regardless identified risk factors. After informed consent, HCV Ab testing was done. As soon as HCV Ab was detected, HCV RNA was done and replicating patients were propose to be treated according to the other pathologies for which the patients was hospitalized. The study was authorized by CPP Toulouse and fees for all biological test was supported by ARS PACA. Results: Between November 2019 and March 2021, 26,679 patients were hospitalized. 2433 patients (9.1%) were included in the DEVICHO study. 58 patients (2.38% 95% CI: 1.78-2.99) had anti-HCV + Ab, of which 46 patients were unaware of their status and 12 patients (0.5%) had HCV + RNA. 10 patients were treated and cured of HCV, one patient died and one patient refused treatment. In the same period 3,605 patients (13.5%) were screened for hepatitis C based on risk factors. 97 patients (2.69% 95% CI: 2.16-3.21) had anti-HCV + antibodies. In total, during the study period, 6,038 patients (22.6%) were screened for hepatitis C and 155 patients (2.56%) had anti-HCV + antibodies. There was no significant difference in the prevalence of HCV between patients screened in the DEVICHO study and those screened for risk factors (p = 0.45). During the study, we noted many difficulties related to the heterogeneity of patient recruitment depending on the hospital services and the occurrence of the COVID-19 pandemic which slowed down inclusions, especially during periods of confinement.We have simplified the inclusion measures with oral consent based on showing movies , pictures, flyers and we tried to implement HCV screening in the entry checks of some department. Conclusion: The prevalence of HCV in hospitalized patients is higher than that observed in the general population in France. Universal screening of all hospitalized patients shows the same HCV prevalence as targeted screening based on risk factors identified according to HAS criteria. Our study also shows, through the low percentage of included patients , that caregivers are the main obstacle to screening for hepatitis.
ABSTRACT
This document, written by the French Association for the Study of the Liver (AFEF) board, aims to provide information to physicians involved in the care of patients with liver disease during the Coronavirus disease (COVID-19) epidemic. These are not based on a systematic review of the literature and a rigorous evaluation using the GRADE method. These are recommendations based on feedback from China available in the form of original articles or letters - for which the scientific evidence is often modest - and the rules put forward by American (1) and European (Boettler et al, 2020) hepatology societies, the French National Digestive Cancer Thesaurus (Di Fiore et al., 2020) and the Francophone Transplantation Society (4). These suggestions require adjustment according to the geographical particularities of the epidemic, available standard procedures and access to local resources. This document will be updated as regularly as possible according to the evolution of our knowledge and characteristics on the epidemic.