Toward a simple risk assessment screening tool for HCV infection in Egypt

A Cross-sectional Study to Identify Risk Factors for Hepatitis C in Punjab, India

BACKGROUND

Hepatitis C virus (HCV) antibody prevalence in Punjab, India (0.56%) is higher than the national average (0.32%), but primary drivers of local transmission are unclear.

OBJECTIVES

The objective of this study was to identify behavioral and demographic predictors of screening positive for HCV in Punjab.

MATERIALS AND METHODS

Interviews assessing exposure to potential HCV risk factors were administered cross-sectionally to persons screening for HCV across 10 treatment facilities. Risk ratios (RRs) were calculated using generalized estimating equation models accounting for clustering by health facility.

RESULTS

One thousand seven hundred and sixty-three patients tested anti-HCV positive; 595 were negative. 57.7% of respondents were male; the median age was 40 years. 13.8% reported injecting drugs. Males were more likely to test positive than females (RR: 1.14, 95% confidence interval [CI]: 1.07-1.21). Unmarried men were at higher risk of anti-HCV positivity compared with married men (RR: 1.16, 95% CI: 1.08-1.24), but unmarried women were at lower risk (RR: 0.65, 95% CI: 0.43-0.98). The strongest risk factors were history of injecting drugs (RR: 1.37, 95% CI: 1.24-1.51), incarceration (RR: 1.22, 95% CI: 1.12-1.33), acupuncture use (RR: 1.20, 95% CI: 1.09-1.33), having household member(s) with a history of incarceration (RR: 1.17, 95% CI: 1.08-1.26), and tattoos (RR: 1.16, 95% CI: 1.09-1.24). Additional risk factors among men included receiving injections in a public hospital or from unregistered medical practitioners and among women included a history of childbirth.

CONCLUSION

Injecting drugs was most strongly associated with anti-HCV positivity in this population. Greater attention to HCV prevention is needed, with a focus on people-centered harm reduction programs, behavioral change interventions, and increasing safety in potential transmission settings.

Performance and modification of EGCRISC among hepatitis C virus high-risk groups

We have previously shown that the Egyptian Hepatitis C Virus Risk Score (EGCRISC), an Egyptian hepatitis C virus (HCV) risk-based screening tool, to be valid and cost-effective. Certain behaviours, occupations and diseases have been shown to be associated with an increased risk of exposure to HCV infection and constitute a major population reservoir of HCV infection. This study investigated the efficacy of EGCRISC in selected high-risk groups by testing 863 participants from four groups: slaughterhouse workers, illicit drug users (IDUs), female sex workers and human immune deficiency virus (HIV) patients. Data for this study were collected on EGCRISC and another pre-designed risk factor questionnaire. Sera were tested for HCV antibodies by ELISA. EGCRISC, at lower cut-off points, showed significantly good performance (P < 0.05) in all four groups except for females <45 years, but was reliable in detecting HCV cases (sensitivity: 84.21% and negative predictive value: 94.5%). Specific scores for IDUs and HIV patients were developed that showed high accuracy (P < 0.001). A modified EGCRISC for high-risk groups (EGCRISC-HRGs) was shown to be a valid tool that is recommended for use in high-risk populations if no other specific screening tool is available or universal screening is applied. EGCRISC for IDUs (EGCRISC-IDUs) and EGCRISC for HIV patients (EGCRISC-HIV) are useful tools for preselecting potentially HCV-infected cases for further testing in settings where serological analysis is not readily available or accessible.

Geospatial epidemiology of hepatitis C infection in Egypt 2017 by governorate

BACKGROUND

Geographic Information Systems (GIS) and spatial epidemiological methods may provide a basis for disease investigation through which hotspots and disease determinants can be identified. Applying these methods for hepatitis C virus (HCV) in Egypt would support a more effective strategy to control its transmission. Therefore, this study used GIS software to draw one of the first HCV maps in Egypt elucidating and analyzing geographical and epidemiological differences in HCV distribution within the country.

METHODS

A cross-sectional survey of 21 governorates (n = 12169, 8080 rural, 3733 urban and 356 slums areas) was completed. All participants were interviewed regarding potential exposures to HCV. Third generation ELISA was used to test serum for HCV antibody. Quantitative real-time RT-PCR was used to test anti-HCV positive subjects for HCV-RNA.

RESULTS

The participants ranged in age from 14-90 years. Overall, anti-HCV sero-prevalence was 14.8%. The prevalence of HCV-RNA, was 9.5%. Proportionally, 65.8% of anti-HCV positives were positive for HCV-RNA. The map of Egyptian governorates highlighted the darkest spot of HCV infection in Menoufeya (37.8%) followed by Beni Suef (29.2%) and Minya (28.6%). Anti-HCV prevalence was higher among males and logistic regression models revealed a strong independent association with increasing age, rural residence and parenteral anti-schistosomal therapy.

CONCLUSIONS

Rural residences and HCV hotspots should be prioritized for HCV prevention programs. The unique age distribution first shown in this study shows that the older age groups (≥60 years old) constitutes a considerable reservoir of infection and must not be neglected.

Cost-effectiveness of EGCRISC application versus hepatitis C virus mass screening in Egypt

BACKGROUND

The Egyptian model of care against hepatitis C virus (HCV) has a great success in treatment and treatment accessibility, but still screening efforts must be strengthened. HCV is a silent infection when most of infected people are unaware of their infection. EGCRISC is a newly developed and validated risk-based HCV screening tool in Egypt that has shown a considerably good performance but is still underused. This brief communication is to analyze its use cost-effectiveness versus mass screening.

STUDY DESIGN

Mathematical comparative analysis for economic evaluation.

METHODS

Its performance data as published recently were used, and a minimum cost of L.E. 20 was considered per one antibody testing. The 2015 health issue survey and population census were used for estimating the population, infected individuals and susceptibles.

RESULTS

The analysis showed that using EGCRISC would save LE 0.43 billion accounting for about 21,646,227 unnecessary tests, while missing less than 70,000 cases when compared to mass screening.

CONCLUSION

EGCRISC is a cost-effective tool that must be adopted nationwide as soon as possible in Egypt for the best outcome of HCV control.

Validation of EGCRISC for Chronic Hepatitis C Infection Screening and Risk Assessment in the Egyptian Population

Chronic HCV infection, a highly endemic disease in Egypt, is usually asymptomatic for decades after infection. Prediction questionnaire tool was proofed to be a valuable, feasible and efficient instrument for the screening of several diseases. We previously developed an Egyptian HCV risk screening tool (EGCRISC). This study aims to validate/modify EGCRISC. A cross-sectional study testing 4579 individuals by EGCRISC as well as ELISA/PCR was performed. The sample was a stratified cluster sampling from urban and rural areas in Upper and Lower Egypt using a proportional allocation technique. The degree of agreement and positive and negative posttest probabilities were calculated. ROC curve was done and the cutoff points were customized for best performance. The total score was further classified into three levels according to the risk load. The mean age of the participants was 41.1±12.2 in whom HCV prevalence was 8.6%. EGCRISC, particularly after modifying the cutoff points, has a good discriminating ability. The degree of agreement was at least 68.1% and the positive posttest probability ranged from 5% to 37.2% whereas the negative posttest probability was in the range 1% to 17%. We conclude that EGCRISC is a valid tool that can potentially screen for HCV infection risk in Egypt and could diminish the demand for mass serologic screening in those apparently at minimal risk. Extensive use of electronic and self- or interviewer-administered risk-based screening strategy may simplify and promote overall screening and detection of HCV dissimilar communities.