ABSTRACT
Many individuals with hepatitis C virus (HCV) infection are undiagnosed. This study evaluates a risk assessment questionnaire, developed for use online to target blood-screening for HCV. Two hundred and eighty-nine patients with known HCV status completed a written questionnaire on prominent HCV risk factors. Questionnaires generated advice to seek testing if at least one risk factor was reported. Agreement of the testing advice with the HCV status of respondents was evaluated. Subsequently, we validated our questionnaire among 985 patients of an outpatient clinic for sexually transmitted infections. The post-test-probability-of-disease (PTPD) and diagnostic gain (PTPD minus prior probability of disease) were calculated. The questionnaire's sensitivity and specificity were 84.6% and 63.8%, respectively, and higher in the STI clinic patients. The PTPD of positive testing advice was 72.5% given HCV prevalence of 53.0%, yielding a diagnostic gain of 19.5%. Applying the estimated prevalence in the general Dutch population (0.1-0.4%), and the anticipated prevalence in the online project (1.0-6.0%), yielded diagnostic gains of 0.13-0.53% and 1.3-7.0%, respectively. We conclude that our questionnaire succeeded in selecting at-risk individuals as its testing advice agreed well with the HCV status. We suggest that the questionnaire be used online as a selection tool for HCV blood-screening in the general population.
Subject(s)
Hepacivirus/isolation & purification , Hepatitis C/diagnosis , Mass Screening/methods , Risk Assessment/methods , Surveys and Questionnaires , Adult , Female , Hepatitis C/epidemiology , Humans , Male , Middle Aged , Netherlands/epidemiology , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To determine how needle-stick injuries are dealt with in the Netherlands. DESIGN: Study using questionnaires. METHOD: In order to study whether victims of needle-stick injuries have access to proper treatment, we sent questionnaires to hospitals (n = 103) and Municipal Health Services (MHS) (n = 36) in the Netherlands. We enquired after the possibilities of risk-estimation and follow-up, the performance of necessary laboratory tests, direct administration of preventive medication and backup facilities. RESULTS: Questionnaires were returned by 113 (81%) institutions. 74% of the hospitals and 71% of the MHS provided follow-up for needle-stick injuries from outside their own institution. Necessary laboratory tests were not always available or sometimes could not be performed on an immediate basis. In addition, essential medication was not always directly available. MHS recognized the advantage of cooperation during followup of needle-stick injuries more than hospitals. CONCLUSION: Based on the results there is no guarantee that victims of needle-stick injuries in the Netherlands have access to appropriate care at any location in the Netherlands on a 24/7 basis. We recommend improvement of the infrastructure and cooperation between health care organizations to guarantee improved follow-up in every region.
