Hcv screening in a tertiary french hospital: Health care professionals are the major impediment!

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.