Juicio del Panel y Evidencia

1.- ¿El problema es una prioridad?

No	Probablemente no	Probablemente sí	Sí	Varía	No lo sé

El problema o condición de salud abordado en la pregunta ha sido definido como prioritario en el marco de las Garantías Explícitas en Salud (GES), régimen integral de salud que prioriza un grupo de patologías o problemas de salud, garantizando el acceso a tratamiento oportuno y de calidad. Además, particularmente, la pregunta ¿En personas mayores de 45 años o de cualquier edad con factores de riesgo ¿Se debe “realizar tamizaje (IgG)” en comparación a “no realizar”? fue priorizada por un panel de expertos en la materia. Ver detalle en Informe de Priorización de Preguntas de Práctica Clínica.

2.- ¿Qué tan significativos son los efectos deseables anticipados?

Trivial	Pequeño	Moderado	Grande	Varía	No lo sé

Moderados: Tomando en cuenta la evidencia identificada, la experiencia clínica y la vivencia de las personas con el problema de salud, el equipo elaborador de la guía estimó que la magnitud de los efectos deseables de «realizar test de tamizaje (IgG)» en comparación a «no hacer» son moderados, y probablemente es importante para la mayoría de las personas.

Evidencia de investigación

tamizaje en personas con factores de riesgo para hepatitis C
Pacientes	Personas mayores de 45 años o de cualquier edad con factores de riesgo.
Intervención	Realizar tamizaje (IgG).
Comparación	No realizar.
Desenlaces	Efecto relativo (IC 95%) — Estudios/ pacientes	Efecto absoluto estimado*			Certeza de la evidencia (GRADE)	Mensajes clave en términos sencillos
Desenlaces		SIN tamizaje	CON tamizaje	Diferencia (IC 95%)	Certeza de la evidencia (GRADE)	Mensajes clave en términos sencillos
Mortalidad Seguimiento: 6 meses	— 1 ensayo/196 pacientes [12]	No se observaron muertes en ninguno de los grupos.			¹ Baja	Realizar tamizaje podría tener poco impacto en mortalidad en personas con factores de riesgo para hepatitis C, pero la certeza de la evidencia es baja.
Calidad de vida	El desenlace calidad de vida no fue medido o reportado por los estudios.				—	—
Morbilidad asociada a hepatitis C Seguimiento: Entre 9 y 18 meses	No se encontraron estudios que evalúen morbilidad asociada a hepatitis C. Sin embargo, se identificó evidencia indirecta: En dos ensayos [8,12] (2.013 pacientes), se pesquisó un mayor número de casos (anticuerpos VHC; RR 2,06; IC 0,84 a 5,07), y en un ensayo [12] aumentó el número de personas que inició terapia antiviral (RR 4,42; IC (0,53 a 37,17).				^2,3 Baja	Realizar tamizaje podría disminuir la morbilidad en personas con factores de riesgo para hepatitis C, pero la certeza de la evidencia es baja.
Aceptabilidad del test Sin seguimiento	Un estudio observacional [27] reportó que el 86% de los pacientes (37/43) estaban satisfechos con la decisión tomada por el test y un 14% no (6/43).				^1,6 Muy baja	Realizar tamizaje podría ser aceptable por las partes interesadas. Sin embargo, existe considerable incertidumbre dado que la certeza de la evidencia es muy baja
Derivación a atención médica** Seguimiento: Entre 6 y 18 meses	RR 1,40 (0,80 a 2,42) — 2 ensayos/151 pacientes [10,12]	439 por 1000	614 por 1000	Diferencia: 175 más (88 menos a 623 más)	^2,4,5 Muy baja	Realizar tamizaje podría aumentar la derivación a atención médica en personas con factores de riesgo de hepatitis C. Sin embargo, existe considerable incertidumbre dado que la certeza de la evidencia es muy baja
Biopsia de hígado Seguimiento: 6 meses	RR 2,27 (1,00 a 5,20) — 1 ensayo/196 pacientes [12]	76 por 1000	173 por 1000	Diferencia: 97 más (0 a 320 más)	Alta	Realizar tamizaje lleva a un aumento en el número de biopsias de hígado realizadas en personas con factores de riesgo para hepatitis C.

IC 95%: Intervalo de confianza del 95% // RR: Riesgo relativo.
GRADE: Grados de evidencia Grading of Recommendations Assessment, Development and Evaluation.
* El riesgo SIN tamizaje está basado en el riesgo del grupo control en los estudios. El riesgo CON tamizaje (y su intervalo de confianza) está calculado a partir del efecto relativo (y su intervalo de confianza).
**Derivación a atención médica cuando el anticuerpo de VHC es positivo.
1 Se disminuyó dos niveles de certeza de evidencia por imprecisión, ya que es estudio único con bajo tamaño muestral para predecir la mortalidad y satisfacción.
2 Se disminuyó un nivel de certeza de evidencia por imprecisión, ya que cada extremo del intervalo de confianza conlleva una decisión diferente.
3 Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que los desenlaces reportados corresponden a desenlaces sustitutos de morbilidad asociada a hepatitis C.
4 Se disminuyó un nivel de certeza de evidencia por riesgo de sesgo ya que en uno de los ensayos [10] no está claro el ocultamiento de la secuencia aleatoria. Además, el ensayo no fue ciego.
5 Se disminuyó un nivel de certeza de la evidencia por inconsistencia, debido a que se observó heterogeneidad significativa entre los estudios (I2=71%)
6 Diseño observacional.
Fecha de elaboración de la tabla: Julio, 2019.

Referencias

1. Jones, Lisa, Bates, Geoff, McCoy, Ellie, Beynon, Caryl, McVeigh, Jim, Bellis, Mark. A systematic review of the effectiveness and cost-effectiveness of interventions aimed at raising awareness and engaging with groups who are at an increased risk of hepatitis B and C infection–final report. Liverpool: Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University. 2012;
2. Kronfli N, Linthwaite B, Kouyoumdjian F, Klein MB, Lebouché B, Sebastiani G, Cox J. Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: A systematic review. The International journal on drug policy. 2018;57:95-103.
3. Chou R, Cottrell EB, Wasson N, Rahman B, Guise JM. Screening for hepatitis C virus infection in adults: a systematic review for the U.S. Preventive Services Task Force. Annals of internal medicine. 2013;158(2):101-8.
4. Zuure FR, Urbanus AT, Langendam MW, Helsper CW, van den Berg CH, Davidovich U, Prins M. Outcomes of hepatitis C screening programs targeted at risk groups hidden in the general population: a systematic review. BMC public health. 2014;14(1):66.
5. Aspinall EJ, Doyle JS, Corson S, Hellard ME, Hunt D, Goldberg D, Nguyen T, Falck-Ytter Y, Morgan RL, Smith B, Stoove M, Wiktor SZ, Hutchinson S. Targeted hepatitis C antibody testing interventions: a systematic review and meta-analysis. European journal of epidemiology. 2015;30(2):115-29.
6. Chou R, Cottrell EB, Wasson N, Rahman B, Guise JM. Screening for Hepatitis C Virus Infection in Adults. AHRQ Comparative Effectiveness Reviews; Rockville (MD): Agency for Healthcare Research and Quality (US); Report No.: 12(13)-EHC090-EF.. 2012;
7. Roudot-Thoraval F, Monnet E, Mercet P, Bastie A, Dhumeaux D, Miguet JP. [Strategies of hepatitis C screening in general practice. Results of a two-center randomized trial]. Gastroentérologie clinique et biologique. 2000;24(11):1037-41.
8. Sahajian F, Bailly F, Vanhems P, Fantino B, Vannier-Nitenberg C, Fabry J, Trepo C, Members of ADHEC. A randomized trial of viral hepatitis prevention among underprivileged people in the Lyon area of France. Journal of public health (Oxford, England). 2011;33(2):182-92.
9. Hickman M, McDonald T, Judd A, Nichols T, Hope V, Skidmore S, Parry JV. Increasing the uptake of hepatitis C virus testing among injecting drug users in specialist drug treatment and prison settings by using dried blood spots for diagnostic testing: a cluster randomized controlled trial. Journal of viral hepatitis. 2008;15(4):250-4.
10. Rosenberg SD, Goldberg RW, Dixon LB, Wolford GL, Slade EP, Himelhoch S, Gallucci G, Potts W, Tapscott S, Welsh CJ. Assessing the STIRR model of best practices for blood-borne infections of clients with severe mental illness. Psychiatric services (Washington, D.C.). 2010;61(9):885-91.
11. Craine N, Whitaker R, Perrett S, Zou L, Hickman M, Lyons M. A stepped wedge cluster randomized control trial of dried blood spot testing to improve the uptake of hepatitis C antibody testing within UK prisons. European journal of public health. 2015;25(2):351-7.
12. Cullen W, Stanley J, Langton D, Kelly Y, Staines A, Bury G. Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines’ implementation. The British journal of general practice : the journal of the Royal College of General Practitioners. 2006;56(532):848-5
13. Costa ZB, Machado GC, Avelino MM, Gomes Filho C, Macedo Filho JV, Minuzzi AL, Turchi MD, Stefani MM, de Souza WV, Martelli CM. Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil. BMC infectious diseases. 2009;9:116.
14. Anderson EM, Mandeville RP, Hutchinson SJ, Cameron SO, Mills PR, Fox R, Ahmed S, Taylor A, Spence E, Goldberg DJ. Evaluation of a general practice based hepatitis C virus screening intervention. Scottish medical journal. 2009;54(3):3-7.
15. Hwang JP, Mohseni M, Gor BJ, Wen S, Guerrero H, Vierling JM. Hepatitis B and hepatitis C prevalence and treatment referral among Asian Americans undergoing community-based hepatitis screening. American journal of public health. 2010;100 Suppl 1:S118-24.
16. Tafuri S, Prato R, Martinelli D, Melpignano L, De Palma M, Quarto M, Germinario C. Prevalence of Hepatitis B, C, HIV and syphilis markers among refugees in Bari, Italy. BMC infectious diseases. 2010;10:213.
17. Seeff LB, Everson GT, Morgan TR, Curto TM, Lee WM, Ghany MG, Shiffman ML, Fontana RJ, Di Bisceglie AM, Bonkovsky HL, Dienstag JL, HALT–C Trial Group. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2010;8(10):877-83.
18. Roberts J, Cull M, Dean G, Richardson D, Fisher M. Improved but still suboptimal uptake of STI testing and vaccination in the outreach setting. 2nd Joint Conference of the British HIV Association and the British Association for Sexual Health and HIV; Manchester, United Kingdom. 2010;:118.
19. Scott C, Day S, Low E, Sullivan A, Atkins M, Asboe D. Unselected hepatitis C screening of men who have sex with men attending sexual health clinics. The Journal of infection. 2010;60(5):351-3.
20. Subiadur J, Harris JL, Rietmeijer CA. Integrating viral hepatitis prevention services into an urban STD clinic: Denver, Colorado. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:12-7.
21. Datta SD, Armstrong GL, Roome AJ, Alter MJ. Blood exposures and hepatitis C virus infections among emergency responders. Archives of internal medicine. 2003;163(21):2605-10.
22. Arumainayagam J, Grimshaw R, Acharya S, Chandramani S, Morrall IA, Pugh RN. Value of targeting at-risk populations at outreach venues: findings from a local sauna. International journal of STD & AIDS. 2009;20(9):642-3.
23. Moussalli J, Delaquaize H, Boubilley D, Lhomme JP, Merleau Ponty J, Sabot D, Kerever A, Valleur M, Poynard T. Factors to improve the management of hepatitis C in drug users: an observational study in an addiction centre. Gastroenterology research and practice. 2010;2010.
24. Altman C, Lesiour A, Dunbavand A, Meyer L, de la Selle P, Buffet C. [Screening of patients at risk for hepatitis C virus infection in general medicine]. Gastroentérologie clinique et biologique. 1999;23(3):359-62.
25. Abusheikha N, Akagbosu F, Marcus S, Lass A, Cousins C, Brinsden P. Viral screening and assisted conception treatment–the Bourn Hall experience. Journal of assisted reproduction and genetics. 1999;16(6):337-9.
26. Foucher J, Reiller B, Jullien V, Léal F, di Cesare ES, Merrouche W, Delile JM, de Lédinghen V. FibroScan used in street-based outreach for drug users is useful for hepatitis C virus screening and management: a prospective study. Journal of viral hepatitis. 2009;16(2):121-31.
27. Trepka MJ, Zhang G, Leguen F, Obiaja K, Malow RM, De La Rosa M. Benefits and adverse effects of hepatitis C screening: early results of a screening program. Journal of public health management and practice : JPHMP. 2007;13(3):263-9.
28. Aitken CK, Kerger M, Crofts N. Peer-delivered hepatitis C testing and counselling: a means of improving the health of injecting drug users. Drug and alcohol review. 2002;21(1):33-7.
29. Freudenreich O, Gandhi RT, Walsh JP, Henderson DC, Goff DC. Hepatitis C in schizophrenia: screening experience in a community-dwelling clozapine cohort. Psychosomatics. 2007;48(5):405-11.
30. Pradat P, Caillat-Vallet E, Sahajian F, Bailly F, Excler G, Sepetjan M, Trépo C, Fabry J, ADHEC members. Prevalence of hepatitis C infection among general practice patients in the Lyon area, France. European journal of epidemiology. 2001;17(1):47-51.
31. Craine N, Parry J, O’Toole J, D’Arcy S, Lyons M. Improving blood-borne viral diagnosis; clinical audit of the uptake of dried blood spot testing offered by a substance misuse service. Journal of viral hepatitis. 2009;16(3):219-22.
32. van der Poorten D, Kwok A, Lam T, Ridley L, Jones DB, Ngu MC, Lee AU. Twenty-year audit of percutaneous liver biopsy in a major Australian teaching hospital. Internal medicine journal. 2006;36(11):692-9.
33. Rodger AJ, Jolley D, Thompson SC, Lanigan A, Crofts N. The impact of diagnosis of hepatitis C virus on quality of life. Hepatology (Baltimore, Md.). 1999;30(5):1299-301.
34. Sahajian F, Excler G, Bailly F, Caillat-Vallet E, Trépo C, Sepetjan M, Fabry JY. Hepatitis C screening practices among private practitioners: impact of an information campaign. Gastroentérologie clinique et biologique. 2005;28(8-9):714-9.
35. Stein K, Dalziel K, Walker A, McIntyre L, Jenkins B, Horne J, Royle P, Round A. Screening for hepatitis c among injecting drug users and in genitourinary medicine clinics: systematic reviews of effectiveness, modelling study and national survey of current practice. Health Technology Assessment. 2002;6(30):1-122.
36. Helsper CW, Borkent-Raven BA, de Wit NJ, van Essen GA, Bonten MJ, Hoepelman AI, Janssen MP, de Wit GA. Cost-effectiveness of targeted screening for hepatitis C in The Netherlands. Epidemiology and infection. 2012;140(1):58-69.
37. Mallette C, Flynn MA, Promrat K. Outcome of screening for hepatitis C virus infection based on risk factors. The American journal of gastroenterology. 2008;103(1):131-7.
38. Fabris P, Tositti G, Giordani MT, Baldo V, Grasso A, Pignattari E, Canton S, Rossato S, Floreani A. Assessing patients’ understanding of hepatitis C virus infection and its impact on their lifestyle. Alimentary pharmacology & therapeutics. 2006;23(8):1161-70.
39. Skipper C, Guy JM, Parkes J, Roderick P, Rosenberg WM. Evaluation of a prison outreach clinic for the diagnosis and prevention of hepatitis C: implications for the national strategy. Gut. 2003;52(10):1500-4.
40. ARèS 92. Interest of a «health course» proposed to the residents of a Sonacotra home. Bulletin epidémiologique hebdomadaire. 2004;43:205–206.
41. Dubois F, François M, Mariotte N, Caces E, Vol S, Roingeard P, Barin F, Goudeau A, Tichet J. Serum alanine aminotransferase measurement as a guide to selective testing for hepatitis C during medical checkup. Journal of hepatology. 1994;21(5):837-41.
42. Chen CH, Yang PM, Huang GT, Lee HS, Sung JL, Sheu JC. Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants. Journal of the Formosan Medical Association = Taiwan yi zhi. 2007;106(2):148-55.
43. D’Souza G, Arafat R, Hwang L, Cunningham C, Shah S, Reynolds K. Cross-sectional survey of the extent and indicators of hepatitis C virus infection in Houston Department of Health and Human Services’ sexually transmitted disease clinics. Journal of viral hepatitis. 2003;10(2):134-40.
44. Groom H, Dieperink E, Nelson DB, Garrard J, Johnson JR, Ewing SL, Stockley H, Durfee J, Jonk Y, Willenbring ML, Ho SB. Outcomes of a Hepatitis C screening program at a large urban VA medical center. Journal of clinical gastroenterology. 2008;42(1):97-106.
45. Boyce DE, Tice AD, Ona FV, Akinaka KT, Lusk H. Viral hepatitis in a homeless shelter in Hawai’i. Hawaii medical journal. 2009;68(5):113-5.
46. Wilkinson M, Crawford V, Tippet A, Jolly F, Turton J, Sims E, Hekker M, Dalton J, Marley R, Foster GR. Community-based treatment for chronic hepatitis C in drug users: high rates of compliance with therapy despite ongoing drug use. Alimentary pharmacology & therapeutics. 2009;29(1):29-37.
47. Torda AJ. Vaccination and screening of medical students: results of a student health initiative. The Medical journal of Australia. 2008;189(9):484-6.
48. Jack K, Willott S, Manners J, Varnam MA, Thomson BJ. Clinical trial: a primary-care-based model for the delivery of anti-viral treatment to injecting drug users infected with hepatitis C. Alimentary pharmacology & therapeutics. 2009;29(1):38-45.
49. Gunn RA, Murray PJ, Ackers ML, Hardison WG, Margolis HS. Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic: rationale for integrating services. Sexually transmitted diseases. 2001;28(3):166-70.
50. Capron D, Bensousan T, Darchis JP, Barbare JC, Butel J, Bental A, Cadranel JF, Goll A, Levy P, Ink O, Autret P, Bouraya D, Thiebaut JM, Moucheron JJ, Bernard M, Lallement PY, Delobel P. Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the ‘Direction Générale de la Santé’. European journal of gastroenterology & hepatology. 1999;11(6):643-8.
51. Weisbord JS, Trepka MJ, Zhang G, Smith IP, Brewer T. Prevalence of and risk factors for hepatitis C virus infection among STD clinic clientele in Miami, Florida. Sexually transmitted infections. 2003;79(1):E1.
52. Zimmerman R, Finley C, Rabins C, McMahon K. Integrating viral hepatitis prevention into STD clinics in Illinois (excluding Chicago), 1999-2005. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:18-23.
53. Uddin G, Shoeb D, Solaiman S, Marley R, Gore C, Ramsay M, Harris R, Ushiro-Lumb I, Moreea S, Alam S, Thomas HC, Khan S, Watt B, Pugh RN, Ramaiah S, Jervis R, Hughes A, Singhal S, Cameron S, Carman WF, Foster GR. Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin. Journal of viral hepatitis. 2010;17(5):327-35.
54. Farrell RJ, Smiddy PF, Pilkington RM, Tobin AA, Mooney EE, Temperley IJ, McDonald GS, Bowmer HA, Wilson GF, Kelleher D. Guided versus blind liver biopsy for chronic hepatitis C: clinical benefits and costs. Journal of hepatology. 1999;30(4):580-7.
55. Tweed E, Brant L, Hurrelle M, Klapper P, Ramsay M, Hepatitis Sentinel Surveillance Study Group. Hepatitis C testing in sexual health services in England, 2002-7: results from sentinel surveillance. Sexually transmitted infections. 2010;86(2):126-30.
56. Lacey C, Ellen S, Devlin H, Wright E, Mijch A. Hepatitis C in psychiatry inpatients: testing rates, prevalence and risk behaviours. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists. 2007;15(4):315-9.
57. Ouzan D, Cavailler P, Hofliger P, Mamino C, Joly H, Tran A. [Modalities of care in anti HCV positive patients identified in General Medicine in the Alpes-Maritimes district]. Gastroentérologie clinique et biologique. 2003;27(4):376-80.
58. Cheung RC, Cunningham BA, Cooper AD. Effectiveness of a screening program for hepatitis C. Digestive diseases and sciences. 2006;51(5):976-81.
59. Myers RP, Fong A, Shaheen AA. Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver international : official journal of the International Association for the Study of the Liver. 2008;28(5):705-12.
60. Batash S, Khaykis I, Raicht RF, Bini EJ. High prevalence of hepatitis C virus infection among immigrants from the former Soviet Union in the New York City metropolitan area: results of a community-based screening program. The American journal of gastroenterology. 2008;103(4):922-7.
61. Campello C, Poli A, Dal MG, Besozzi-Valentini F. Seroprevalence, viremia and genotype distribution of hepatitis C virus: a community-based population study in northern Italy. Infection. 2002;30(1):7-12.
62. Goetz AM, Ndimbie OK, Wagener MM, Muder RR. Prevalence of hepatitis C infection in health care workers affiliated with a liver transplant center. Transplantation. 1995;59(7):990-4.
63. Fagundes GD, Bonazza V, Ceretta LB, Back AJ, Bettiol J. Detection of the Hepatitis C virus in a population of adults. Revista latino-americana de enfermagem. 2008;16(3):396-400.
64. Defossez G, Verneau A, Ingrand I, Silvain C, Ingrand P, Beauchant M, Poitou-Charentes Hepatitis C Network. Evaluation of the French national plan to promote screening and early management of viral hepatitis C, between 1997 and 2003: a comparative cross-sectional study in Poitou-Charentes region. European journal of gastroenterology & hepatology. 2008;20(5):367-72.
65. Alexanian AA, Oleszkiewicz GM, Al-Chalabi T, Atabani S, Muir D, Tudor-Williams G, Brown AS. Observational outcomes in a cohort of women identified as hepatitis C (HCV) antibody positive during routine antenatal clinic (ANC) screening. 60th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting; Boston, MA, United States. Published in: Hepatology. 2009;:669A.
66. Zuniga IA, Chen JJ, Lane DS, Allmer J, Jimenez-Lucho VE. Analysis of a hepatitis C screening programme for US veterans. Epidemiology and infection. 2006;134(2):249-57.
67. Fischer LR, Conboy KS, Tope DH, Shewmake DK. Educating health professionals: a hepatitis C educational program in a health maintenance organization. The American journal of managed care. 2000;6(9):1029-36.
68. Grebely J, Knight E, Genoway KA, Viljoen M, Khara M, Elliott D, Gallagher L, Storms M, Raffa JD, DeVlaming S, Duncan F, Conway B. Optimizing assessment and treatment for hepatitis C virus infection in illicit drug users: a novel model incorporating multidisciplinary care and peer support. European journal of gastroenterology & hepatology. 2010;22(3):270-7.
69. Lewis, H., Burke, K., Begum, S., Ushiro-Limb, I., Foster, G.. 903 WHAT IS THE BEST METHOD OF CASE FINDING FOR CHRONIC VIRAL HEPATITIS IN AT-RISK MIGRANT COMMUNITIES?. Journal of Hepatology. 2012;56:S351.
70. Harris KA, Arnsten JH, Litwin AH. Successful integration of hepatitis C evaluation and treatment services with methadone maintenance. Journal of addiction medicine. 2010;4(1):20-6.
71. Bellentani S, Tiribelli C, Saccoccio G, Sodde M, Fratti N, De Martin C, Cristianini G. Prevalence of chronic liver disease in the general population of northern Italy: the Dionysos Study. Hepatology (Baltimore, Md.). 1994;20(6):1442-9.
72. Helsper CW, van Essen GA, Bonten MJ, de Wit NJ. A support programme for primary care leads to substantial improvements in the effectiveness of a public hepatitis C campaign. Family practice. 2010;27(3):328-32.
73. Hayashi J, Kishihara Y, Yamaji K, Yoshimura E, Kawakami Y, Akazawa K, Kashiwagi S. Transmission of hepatitis C virus by health care workers in a rural area of Japan. The American journal of gastroenterology. 1995;90(5):794-9.
74. Thomas DL, Factor SH, Kelen GD, Washington AS, Taylor E, Quinn TC. Viral hepatitis in health care personnel at The Johns Hopkins Hospital. The seroprevalence of and risk factors for hepatitis B virus and hepatitis C virus infection. Archives of internal medicine. 1993;153(14):1705-12.
75. D’Souza RF, Glynn MJ, Alstead E, Foster GR, Ushiro-Lumb I. Improving hepatitis C services across the UK: response to a walk-in HCV testing service. Gut. 2004;53(9):1388.
76. Rainey, J., Robbins, L., Matthews, S., Elphingstone, J., et al. An evaluation of the Florida Department of Health hepatitis programme. Conway, University of Central Arkansas. 2005;
77. Cullen BL, Hutchinson SJ, Cameron SO, Anderson E, Ahmed S, Spence E, Mills PR, Mandeville R, Forrest E, Washington M, Wong R, Fox R, Goldberg DJ. Identifying former injecting drug users infected with hepatitis C: an evaluation of a general practice-based case-finding intervention. Journal of public health (Oxford, England). 2012;34(1):14-23.
78. Alswaidi FM, O’Brien SJ. Is there a need to include HIV, HBV and HCV viruses in the Saudi premarital screening program on the basis of their prevalence and transmission risk factors?. Journal of epidemiology and community health. 2010;64(11):989-97.
79. Surjadi M, Torruellas C, Ayala C, Yee HF, Khalili M. Formal patient education improves patient knowledge of hepatitis C in vulnerable populations. Digestive diseases and sciences. 2011;56(1):213-9.
80. Winter RJ, White B, Kinner SA, Stoové M, Guy R, Hellard ME. A nurse-led intervention improved blood-borne virus testing and vaccination in Victorian prisons. Australian and New Zealand journal of public health. 2016;40(6):592-594.
81. McGinn T, O’Connor-Moore N, Alfandre D, Gardenier D, Wisnivesky J. Validation of a hepatitis C screening tool in primary care. Archives of internal medicine. 2008;168(18):2009-13.
82. Tait JM, McIntyre PG, McLeod S, Nathwani D, Dillon JF. The impact of a managed care network on attendance, follow-up and treatment at a hepatitis C specialist centre. Journal of viral hepatitis. 2010;17(10):698-704.
83. Garrard J, Choudary V, Groom H, Dieperink E, Willenbring ML, Durfee JM, Ho SB. Organizational change in management of hepatitis C: evaluation of a CME program. The Journal of continuing education in the health professions. 2006;26(2):145-60.
84. Jimenez FP, Fuentes HM, Borbolla Busquet E. [Anti-HCV in patients transfused, in a health area attended by a family physician. Medical Office 19 de Abril]. Acta gastroenterologica Latinoamericana. 2000;30(2):99-105.
85. Panlilio AL, Shapiro CN, Schable CA, Mendelson MH, Montecalvo MA, Kunches LM, Perry SW, Edwards JR, Srivastava PU, Culver DH. Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons. Serosurvey Study Group. Journal of the American College of Surgeons. 1995;180(1):16-24.
86. Monnet E, Mercet P, Woronoff-Lemsi MC, Bresson-Hadni S, Pruniaux J, Cottray P, Bouiller C, Allemand H, Miguet JP. [Organized hepatitis C screening. Results and cost of a one-year campaign in a pilot area]. Gastroentérologie clinique et biologique. 2000;24(5):541-6.
87. Gershon RR, Vlahov D, Farzadegan H, Alter MJ. Occupational risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infections among funeral service practitioners in Maryland. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 1995;16(4):194-7.
88. Zdanuk S, Gimpel J, Uhanova J, Kaita KD, Minuk GY. The impact of medical informatics on the confidence of rural physicians caring for patients with chronic hepatitis C viral infections. Family practice. 2001;18(6):602-4.
89. Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology (Baltimore, Md.). 2001;33(1):196-200.
90. Aslam M, Aslam J. Seroprevalence of the antibody to hepatitis C in select groups in the Punjab region of Pakistan. Journal of clinical gastroenterology. 2001;33(5):407-11.
91. Gunewardene R, Lampe L, Ilchef R. Prevalence of hepatitis C in two inpatient psychiatry populations. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists. 2010;18(4):330-4.
92. Zuure F, Davidovich U, Kok G, Depla AC, Hoebe C, van den Hoek A, Jansen PL, van Leeuwen-Gilbert P, Weegink CJ, Coutinho RA, Prins M. Evaluation of a risk assessment questionnaire to assist hepatitis C screening in the general population. Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 2010;15(15):19539.
93. Upfal MJ, Naylor P, Mutchnick MM. Hepatitis C screening and prevalence among urban public safety workers. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 2001;43(4):402-11.
94. McLeod A, Weir A, Aitken C, Gunson R, Templeton K, Molyneaux P, McIntyre P, McDonald S, Goldberg D, Hutchinson S. Rise in testing and diagnosis associated with Scotland’s Action Plan on Hepatitis C and introduction of dried blood spot testing. Journal of epidemiology and community health. 2014;68(12):1182-8.
95. Gunn RA, Murray PJ, Brennan CH, Callahan DB, Alter MJ, Margolis HS. Evaluation of screening criteria to identify persons with hepatitis C virus infection among sexually transmitted disease clinic clients: results from the San Diego Viral Hepatitis Integration Project. Sexually transmitted diseases. 2003;30(4):340-4.
96. Ward C, Tudor-Williams G, Cotzias T, Hargreaves S, Regan L, Foster GR. Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing. Gut. 2000;47(2):277-80.
97. Kallman JB, Tran S, Arsalla A, Haddad D, Stepanova M, Fang Y, Wrobel VJ, Srishord M, Younossi ZM. Vietnamese community screening for hepatitis B virus and hepatitis C virus. Journal of viral hepatitis. 2011;18(1):70-6.
98. Atwell TD, Smith RL, Hesley GK, Callstrom MR, Schleck CD, Harmsen WS, Charboneau JW, Welch TJ. Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. AJR. American journal of roentgenology. 2010;194(3):784-9.
99. Huang JF, Hsieh MY, Dai CY, Hou NJ, Lee LP, Lin ZY, Chen SC, Wang LY, Hsieh MY, Chang WY, Yu ML, Chuang WL. The incidence and risks of liver biopsy in non-cirrhotic patients: An evaluation of 3806 biopsies. Gut. 2007;56(5):736-7.
100. Josset V, Torre JP, Tavolacci MP, Van Rossem-Magnani V, Anselme K, Merle V, Godart J, Libert A, Ladner J, Czernichow P. Efficiency of hepatitis C virus screening strategies in general practice. Gastroentérologie clinique et biologique. 2004;28(4):351-7.
101. Plard C, Shelly M, Millot J, Segouin C, Bertrand D, Le Divenah A. [Anonymous and free screenings: population comparison between those conducted on-site in a testing centre and those done off-site]. Santé publique (Vandoeuvre-lès-Nancy, France). 2007;19(5):355-62.
102. Cohen DE, Russell CJ, Golub SA, Mayer KH. Prevalence of hepatitis C virus infection among men who have sex with men at a Boston community health center and its association with markers of high-risk behavior. AIDS patient care and STDs. 2006;20(8):557-64.
103. Rifai MA, Moles JK, Lehman LP, Van der Linden BJ. Hepatitis C screening and treatment outcomes in patients with substance use/dependence disorders. Psychosomatics. 2006;47(2):112-21.
104. Stockman LJ, Greer J, Holzmacher R, Dittmann B, Hoftiezer SA, Alsum LE, Prieve A, Westergaard RP, Guilfoyle SM, Vergeront JM. Performance of Risk-Based and Birth-Cohort Strategies for Identifying Hepatitis C Virus Infection Among People Entering Prison, Wisconsin, 2014. Public health reports (Washington, D.C. : 1974). 2016;131(4):544-51.
105. Stein K, Dalziel K, Walker A, Jenkins B, Round A, Royle P. Screening for hepatitis C in genito-urinary medicine clinics: a cost utility analysis. Journal of hepatology. 2003;39(5):814-25.
106. Brewer DD, Hagan H. Evaluation of a patient referral contact tracing programme for hepatitis B and C virus infection in drug injectors. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2009;14(14):5-9.
107. Leikin EL, Reinus JF, Schmell E, Tejani N. Epidemiologic predictors of hepatitis C virus infection in pregnant women. Obstetrics and gynecology. 1994;84(4):529-34.
108. Nguyen MT, Herrine SK, Laine CA, Ruth K, Weinberg DS. Description of a new hepatitis C risk assessment tool. Archives of internal medicine. 2005;165(17):2013-8.
109. Lu SN, Chen HC, Tang CM, Wu MH, Yu ML, Chuang WL, Lu CF, Chang WY, Chen CJ. Prevalence and manifestations of hepatitis C seropositivity in children in an endemic area. The Pediatric infectious disease journal. 1998;17(2):142-5.
110. Heseltine G, McFarlane J. Texas statewide hepatitis C counseling and testing, 2000-2005. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:6-11.
111. Pauti MD, Simonnot N, Estecahandy P. [Development of prevention programmes for HIV, hepatitis and sexually transmitted infections among migrants consulting in the doctors of the World French centers]. Médecine et maladies infectieuses. 2008;38(9):495-9.
112. West J, Card TR. Reduced mortality rates following elective percutaneous liver biopsies. Gastroenterology. 2010;139(4):1230-7.
113. Sutton, A. Protecting Injecting Drug Users against Blood-Borne Viruses: Modelling the impact of prison-based interventions. University of Warwick. 2006;
114. Kaur S, Rybicki L, Bacon BR, Gollan JL, Rustgi VK, Carey WD. Performance characteristics and results of a large-scale screening program for viral hepatitis and risk factors associated with exposure to viral hepatitis B and C: results of the National Hepatitis Screening Survey. National Hepatitis Surveillance Group. Hepatology (Baltimore, Md.). 1996;24(5):979-86.
115. Mapagu MC, Martin SJ, Currie MJ, Bowden FJ. Screening for hepatitis C in sexual health clinic attendees. Sexual health. 2008;5(1):73-6.
116. Ellks R. Hepatitis C testing should be performed routinely in all patients attending sexual health services. 2nd Joint Conference of the British HIV Association and the British Association for Sexual Health and HIV Manchester United Kingdom. Published in: HIV Med. 2010;:59.
117. Grebely J, Genoway K, Khara M, Duncan F, Viljoen M, Elliott D, Raffa JD, DeVlaming S, Conway B. Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepatitis C virus infection. The International journal on drug policy. 2007;18(5):437-43.
118. Lindenburg CE, Lambers FA, Urbanus AT, Schinkel J, Jansen PL, Krol A, Casteelen G, van Santen G, van den Berg CH, Coutinho RA, Prins M, Weegink CJ. Hepatitis C testing and treatment among active drug users in Amsterdam: results from the DUTCH-C project. European journal of gastroenterology & hepatology. 2011;23(1):23-31.
119. Hennessy RR, Weisfuse IB, Schlanger K. Does integrating viral hepatitis services into a public STD clinic attract injection drug users for care?. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:31-5.

Búsqueda y Síntesis de Evidencia

Búsqueda y síntesis de evidencia de efectos deseables e indeseables

3.- ¿Qué tan significativos son los efectos indeseables anticipados?

Grande	Moderado	Pequeño	Trivial	Varía	No lo sé

Pequeños: Tomando en cuenta la evidencia identificada, la experiencia clínica y la vivencia de las personas con el problema de salud, el equipo elaborador de la guía estimó que la magnitud de los efectos indeseables «realizar test de tamizaje (IgG)» en comparación a «no hacer» es pequeña, aunque podría ser importante para algunas personas

Consideraciones Adicionales

El efecto adverso reportado en los estudios corresponde a la realización de biopsia hepática, pero el panel refiere que es un procedimiento que ya no es considerado como parte del estudio de rutina de etapificación actual de hepatitis C

Evidencia de investigación

tamizaje en personas con factores de riesgo para hepatitis C
Pacientes	Personas mayores de 45 años o de cualquier edad con factores de riesgo.
Intervención	Realizar tamizaje (IgG).
Comparación	No realizar.
Desenlaces	Efecto relativo (IC 95%) — Estudios/ pacientes	Efecto absoluto estimado*			Certeza de la evidencia (GRADE)	Mensajes clave en términos sencillos
Desenlaces		SIN tamizaje	CON tamizaje	Diferencia (IC 95%)	Certeza de la evidencia (GRADE)	Mensajes clave en términos sencillos
Mortalidad Seguimiento: 6 meses	— 1 ensayo/196 pacientes [12]	No se observaron muertes en ninguno de los grupos.			¹ Baja	Realizar tamizaje podría tener poco impacto en mortalidad en personas con factores de riesgo para hepatitis C, pero la certeza de la evidencia es baja.
Calidad de vida	El desenlace calidad de vida no fue medido o reportado por los estudios.				—	—
Morbilidad asociada a hepatitis C Seguimiento: Entre 9 y 18 meses	No se encontraron estudios que evalúen morbilidad asociada a hepatitis C. Sin embargo, se identificó evidencia indirecta: En dos ensayos [8,12] (2.013 pacientes), se pesquisó un mayor número de casos (anticuerpos VHC; RR 2,06; IC 0,84 a 5,07), y en un ensayo [12] aumentó el número de personas que inició terapia antiviral (RR 4,42; IC (0,53 a 37,17).				^2,3 Baja	Realizar tamizaje podría disminuir la morbilidad en personas con factores de riesgo para hepatitis C, pero la certeza de la evidencia es baja.
Aceptabilidad del test Sin seguimiento	Un estudio observacional [27] reportó que el 86% de los pacientes (37/43) estaban satisfechos con la decisión tomada por el test y un 14% no (6/43).				^1,6 Muy baja	Realizar tamizaje podría ser aceptable por las partes interesadas. Sin embargo, existe considerable incertidumbre dado que la certeza de la evidencia es muy baja
Derivación a atención médica** Seguimiento: Entre 6 y 18 meses	RR 1,40 (0,80 a 2,42) — 2 ensayos/151 pacientes [10,12]	439 por 1000	614 por 1000	Diferencia: 175 más (88 menos a 623 más)	^2,4,5 Muy baja	Realizar tamizaje podría aumentar la derivación a atención médica en personas con factores de riesgo de hepatitis C. Sin embargo, existe considerable incertidumbre dado que la certeza de la evidencia es muy baja
Biopsia de hígado Seguimiento: 6 meses	RR 2,27 (1,00 a 5,20) — 1 ensayo/196 pacientes [12]	76 por 1000	173 por 1000	Diferencia: 97 más (0 a 320 más)	Alta	Realizar tamizaje lleva a un aumento en el número de biopsias de hígado realizadas en personas con factores de riesgo para hepatitis C.

IC 95%: Intervalo de confianza del 95% // RR: Riesgo relativo.
GRADE: Grados de evidencia Grading of Recommendations Assessment, Development and Evaluation.
* El riesgo SIN tamizaje está basado en el riesgo del grupo control en los estudios. El riesgo CON tamizaje (y su intervalo de confianza) está calculado a partir del efecto relativo (y su intervalo de confianza).
**Derivación a atención médica cuando el anticuerpo de VHC es positivo.
1 Se disminuyó dos niveles de certeza de evidencia por imprecisión, ya que es estudio único con bajo tamaño muestral para predecir la mortalidad y satisfacción.
2 Se disminuyó un nivel de certeza de evidencia por imprecisión, ya que cada extremo del intervalo de confianza conlleva una decisión diferente.
3 Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que los desenlaces reportados corresponden a desenlaces sustitutos de morbilidad asociada a hepatitis C.
4 Se disminuyó un nivel de certeza de evidencia por riesgo de sesgo ya que en uno de los ensayos [10] no está claro el ocultamiento de la secuencia aleatoria. Además, el ensayo no fue ciego.
5 Se disminuyó un nivel de certeza de la evidencia por inconsistencia, debido a que se observó heterogeneidad significativa entre los estudios (I2=71%)
6 Diseño observacional.
Fecha de elaboración de la tabla: Julio, 2019.

Referencias

1. Jones, Lisa, Bates, Geoff, McCoy, Ellie, Beynon, Caryl, McVeigh, Jim, Bellis, Mark. A systematic review of the effectiveness and cost-effectiveness of interventions aimed at raising awareness and engaging with groups who are at an increased risk of hepatitis B and C infection–final report. Liverpool: Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University. 2012;
2. Kronfli N, Linthwaite B, Kouyoumdjian F, Klein MB, Lebouché B, Sebastiani G, Cox J. Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: A systematic review. The International journal on drug policy. 2018;57:95-103.
3. Chou R, Cottrell EB, Wasson N, Rahman B, Guise JM. Screening for hepatitis C virus infection in adults: a systematic review for the U.S. Preventive Services Task Force. Annals of internal medicine. 2013;158(2):101-8.
4. Zuure FR, Urbanus AT, Langendam MW, Helsper CW, van den Berg CH, Davidovich U, Prins M. Outcomes of hepatitis C screening programs targeted at risk groups hidden in the general population: a systematic review. BMC public health. 2014;14(1):66.
5. Aspinall EJ, Doyle JS, Corson S, Hellard ME, Hunt D, Goldberg D, Nguyen T, Falck-Ytter Y, Morgan RL, Smith B, Stoove M, Wiktor SZ, Hutchinson S. Targeted hepatitis C antibody testing interventions: a systematic review and meta-analysis. European journal of epidemiology. 2015;30(2):115-29.
6. Chou R, Cottrell EB, Wasson N, Rahman B, Guise JM. Screening for Hepatitis C Virus Infection in Adults. AHRQ Comparative Effectiveness Reviews; Rockville (MD): Agency for Healthcare Research and Quality (US); Report No.: 12(13)-EHC090-EF.. 2012;
7. Roudot-Thoraval F, Monnet E, Mercet P, Bastie A, Dhumeaux D, Miguet JP. [Strategies of hepatitis C screening in general practice. Results of a two-center randomized trial]. Gastroentérologie clinique et biologique. 2000;24(11):1037-41.
8. Sahajian F, Bailly F, Vanhems P, Fantino B, Vannier-Nitenberg C, Fabry J, Trepo C, Members of ADHEC. A randomized trial of viral hepatitis prevention among underprivileged people in the Lyon area of France. Journal of public health (Oxford, England). 2011;33(2):182-92.
9. Hickman M, McDonald T, Judd A, Nichols T, Hope V, Skidmore S, Parry JV. Increasing the uptake of hepatitis C virus testing among injecting drug users in specialist drug treatment and prison settings by using dried blood spots for diagnostic testing: a cluster randomized controlled trial. Journal of viral hepatitis. 2008;15(4):250-4.
10. Rosenberg SD, Goldberg RW, Dixon LB, Wolford GL, Slade EP, Himelhoch S, Gallucci G, Potts W, Tapscott S, Welsh CJ. Assessing the STIRR model of best practices for blood-borne infections of clients with severe mental illness. Psychiatric services (Washington, D.C.). 2010;61(9):885-91.
11. Craine N, Whitaker R, Perrett S, Zou L, Hickman M, Lyons M. A stepped wedge cluster randomized control trial of dried blood spot testing to improve the uptake of hepatitis C antibody testing within UK prisons. European journal of public health. 2015;25(2):351-7.
12. Cullen W, Stanley J, Langton D, Kelly Y, Staines A, Bury G. Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines’ implementation. The British journal of general practice : the journal of the Royal College of General Practitioners. 2006;56(532):848-5
13. Costa ZB, Machado GC, Avelino MM, Gomes Filho C, Macedo Filho JV, Minuzzi AL, Turchi MD, Stefani MM, de Souza WV, Martelli CM. Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil. BMC infectious diseases. 2009;9:116.
14. Anderson EM, Mandeville RP, Hutchinson SJ, Cameron SO, Mills PR, Fox R, Ahmed S, Taylor A, Spence E, Goldberg DJ. Evaluation of a general practice based hepatitis C virus screening intervention. Scottish medical journal. 2009;54(3):3-7.
15. Hwang JP, Mohseni M, Gor BJ, Wen S, Guerrero H, Vierling JM. Hepatitis B and hepatitis C prevalence and treatment referral among Asian Americans undergoing community-based hepatitis screening. American journal of public health. 2010;100 Suppl 1:S118-24.
16. Tafuri S, Prato R, Martinelli D, Melpignano L, De Palma M, Quarto M, Germinario C. Prevalence of Hepatitis B, C, HIV and syphilis markers among refugees in Bari, Italy. BMC infectious diseases. 2010;10:213.
17. Seeff LB, Everson GT, Morgan TR, Curto TM, Lee WM, Ghany MG, Shiffman ML, Fontana RJ, Di Bisceglie AM, Bonkovsky HL, Dienstag JL, HALT–C Trial Group. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2010;8(10):877-83.
18. Roberts J, Cull M, Dean G, Richardson D, Fisher M. Improved but still suboptimal uptake of STI testing and vaccination in the outreach setting. 2nd Joint Conference of the British HIV Association and the British Association for Sexual Health and HIV; Manchester, United Kingdom. 2010;:118.
19. Scott C, Day S, Low E, Sullivan A, Atkins M, Asboe D. Unselected hepatitis C screening of men who have sex with men attending sexual health clinics. The Journal of infection. 2010;60(5):351-3.
20. Subiadur J, Harris JL, Rietmeijer CA. Integrating viral hepatitis prevention services into an urban STD clinic: Denver, Colorado. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:12-7.
21. Datta SD, Armstrong GL, Roome AJ, Alter MJ. Blood exposures and hepatitis C virus infections among emergency responders. Archives of internal medicine. 2003;163(21):2605-10.
22. Arumainayagam J, Grimshaw R, Acharya S, Chandramani S, Morrall IA, Pugh RN. Value of targeting at-risk populations at outreach venues: findings from a local sauna. International journal of STD & AIDS. 2009;20(9):642-3.
23. Moussalli J, Delaquaize H, Boubilley D, Lhomme JP, Merleau Ponty J, Sabot D, Kerever A, Valleur M, Poynard T. Factors to improve the management of hepatitis C in drug users: an observational study in an addiction centre. Gastroenterology research and practice. 2010;2010.
24. Altman C, Lesiour A, Dunbavand A, Meyer L, de la Selle P, Buffet C. [Screening of patients at risk for hepatitis C virus infection in general medicine]. Gastroentérologie clinique et biologique. 1999;23(3):359-62.
25. Abusheikha N, Akagbosu F, Marcus S, Lass A, Cousins C, Brinsden P. Viral screening and assisted conception treatment–the Bourn Hall experience. Journal of assisted reproduction and genetics. 1999;16(6):337-9.
26. Foucher J, Reiller B, Jullien V, Léal F, di Cesare ES, Merrouche W, Delile JM, de Lédinghen V. FibroScan used in street-based outreach for drug users is useful for hepatitis C virus screening and management: a prospective study. Journal of viral hepatitis. 2009;16(2):121-31.
27. Trepka MJ, Zhang G, Leguen F, Obiaja K, Malow RM, De La Rosa M. Benefits and adverse effects of hepatitis C screening: early results of a screening program. Journal of public health management and practice : JPHMP. 2007;13(3):263-9.
28. Aitken CK, Kerger M, Crofts N. Peer-delivered hepatitis C testing and counselling: a means of improving the health of injecting drug users. Drug and alcohol review. 2002;21(1):33-7.
29. Freudenreich O, Gandhi RT, Walsh JP, Henderson DC, Goff DC. Hepatitis C in schizophrenia: screening experience in a community-dwelling clozapine cohort. Psychosomatics. 2007;48(5):405-11.
30. Pradat P, Caillat-Vallet E, Sahajian F, Bailly F, Excler G, Sepetjan M, Trépo C, Fabry J, ADHEC members. Prevalence of hepatitis C infection among general practice patients in the Lyon area, France. European journal of epidemiology. 2001;17(1):47-51.
31. Craine N, Parry J, O’Toole J, D’Arcy S, Lyons M. Improving blood-borne viral diagnosis; clinical audit of the uptake of dried blood spot testing offered by a substance misuse service. Journal of viral hepatitis. 2009;16(3):219-22.
32. van der Poorten D, Kwok A, Lam T, Ridley L, Jones DB, Ngu MC, Lee AU. Twenty-year audit of percutaneous liver biopsy in a major Australian teaching hospital. Internal medicine journal. 2006;36(11):692-9.
33. Rodger AJ, Jolley D, Thompson SC, Lanigan A, Crofts N. The impact of diagnosis of hepatitis C virus on quality of life. Hepatology (Baltimore, Md.). 1999;30(5):1299-301.
34. Sahajian F, Excler G, Bailly F, Caillat-Vallet E, Trépo C, Sepetjan M, Fabry JY. Hepatitis C screening practices among private practitioners: impact of an information campaign. Gastroentérologie clinique et biologique. 2005;28(8-9):714-9.
35. Stein K, Dalziel K, Walker A, McIntyre L, Jenkins B, Horne J, Royle P, Round A. Screening for hepatitis c among injecting drug users and in genitourinary medicine clinics: systematic reviews of effectiveness, modelling study and national survey of current practice. Health Technology Assessment. 2002;6(30):1-122.
36. Helsper CW, Borkent-Raven BA, de Wit NJ, van Essen GA, Bonten MJ, Hoepelman AI, Janssen MP, de Wit GA. Cost-effectiveness of targeted screening for hepatitis C in The Netherlands. Epidemiology and infection. 2012;140(1):58-69.
37. Mallette C, Flynn MA, Promrat K. Outcome of screening for hepatitis C virus infection based on risk factors. The American journal of gastroenterology. 2008;103(1):131-7.
38. Fabris P, Tositti G, Giordani MT, Baldo V, Grasso A, Pignattari E, Canton S, Rossato S, Floreani A. Assessing patients’ understanding of hepatitis C virus infection and its impact on their lifestyle. Alimentary pharmacology & therapeutics. 2006;23(8):1161-70.
39. Skipper C, Guy JM, Parkes J, Roderick P, Rosenberg WM. Evaluation of a prison outreach clinic for the diagnosis and prevention of hepatitis C: implications for the national strategy. Gut. 2003;52(10):1500-4.
40. ARèS 92. Interest of a «health course» proposed to the residents of a Sonacotra home. Bulletin epidémiologique hebdomadaire. 2004;43:205–206.
41. Dubois F, François M, Mariotte N, Caces E, Vol S, Roingeard P, Barin F, Goudeau A, Tichet J. Serum alanine aminotransferase measurement as a guide to selective testing for hepatitis C during medical checkup. Journal of hepatology. 1994;21(5):837-41.
42. Chen CH, Yang PM, Huang GT, Lee HS, Sung JL, Sheu JC. Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants. Journal of the Formosan Medical Association = Taiwan yi zhi. 2007;106(2):148-55.
43. D’Souza G, Arafat R, Hwang L, Cunningham C, Shah S, Reynolds K. Cross-sectional survey of the extent and indicators of hepatitis C virus infection in Houston Department of Health and Human Services’ sexually transmitted disease clinics. Journal of viral hepatitis. 2003;10(2):134-40.
44. Groom H, Dieperink E, Nelson DB, Garrard J, Johnson JR, Ewing SL, Stockley H, Durfee J, Jonk Y, Willenbring ML, Ho SB. Outcomes of a Hepatitis C screening program at a large urban VA medical center. Journal of clinical gastroenterology. 2008;42(1):97-106.
45. Boyce DE, Tice AD, Ona FV, Akinaka KT, Lusk H. Viral hepatitis in a homeless shelter in Hawai’i. Hawaii medical journal. 2009;68(5):113-5.
46. Wilkinson M, Crawford V, Tippet A, Jolly F, Turton J, Sims E, Hekker M, Dalton J, Marley R, Foster GR. Community-based treatment for chronic hepatitis C in drug users: high rates of compliance with therapy despite ongoing drug use. Alimentary pharmacology & therapeutics. 2009;29(1):29-37.
47. Torda AJ. Vaccination and screening of medical students: results of a student health initiative. The Medical journal of Australia. 2008;189(9):484-6.
48. Jack K, Willott S, Manners J, Varnam MA, Thomson BJ. Clinical trial: a primary-care-based model for the delivery of anti-viral treatment to injecting drug users infected with hepatitis C. Alimentary pharmacology & therapeutics. 2009;29(1):38-45.
49. Gunn RA, Murray PJ, Ackers ML, Hardison WG, Margolis HS. Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic: rationale for integrating services. Sexually transmitted diseases. 2001;28(3):166-70.
50. Capron D, Bensousan T, Darchis JP, Barbare JC, Butel J, Bental A, Cadranel JF, Goll A, Levy P, Ink O, Autret P, Bouraya D, Thiebaut JM, Moucheron JJ, Bernard M, Lallement PY, Delobel P. Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the ‘Direction Générale de la Santé’. European journal of gastroenterology & hepatology. 1999;11(6):643-8.
51. Weisbord JS, Trepka MJ, Zhang G, Smith IP, Brewer T. Prevalence of and risk factors for hepatitis C virus infection among STD clinic clientele in Miami, Florida. Sexually transmitted infections. 2003;79(1):E1.
52. Zimmerman R, Finley C, Rabins C, McMahon K. Integrating viral hepatitis prevention into STD clinics in Illinois (excluding Chicago), 1999-2005. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:18-23.
53. Uddin G, Shoeb D, Solaiman S, Marley R, Gore C, Ramsay M, Harris R, Ushiro-Lumb I, Moreea S, Alam S, Thomas HC, Khan S, Watt B, Pugh RN, Ramaiah S, Jervis R, Hughes A, Singhal S, Cameron S, Carman WF, Foster GR. Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin. Journal of viral hepatitis. 2010;17(5):327-35.
54. Farrell RJ, Smiddy PF, Pilkington RM, Tobin AA, Mooney EE, Temperley IJ, McDonald GS, Bowmer HA, Wilson GF, Kelleher D. Guided versus blind liver biopsy for chronic hepatitis C: clinical benefits and costs. Journal of hepatology. 1999;30(4):580-7.
55. Tweed E, Brant L, Hurrelle M, Klapper P, Ramsay M, Hepatitis Sentinel Surveillance Study Group. Hepatitis C testing in sexual health services in England, 2002-7: results from sentinel surveillance. Sexually transmitted infections. 2010;86(2):126-30.
56. Lacey C, Ellen S, Devlin H, Wright E, Mijch A. Hepatitis C in psychiatry inpatients: testing rates, prevalence and risk behaviours. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists. 2007;15(4):315-9.
57. Ouzan D, Cavailler P, Hofliger P, Mamino C, Joly H, Tran A. [Modalities of care in anti HCV positive patients identified in General Medicine in the Alpes-Maritimes district]. Gastroentérologie clinique et biologique. 2003;27(4):376-80.
58. Cheung RC, Cunningham BA, Cooper AD. Effectiveness of a screening program for hepatitis C. Digestive diseases and sciences. 2006;51(5):976-81.
59. Myers RP, Fong A, Shaheen AA. Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver international : official journal of the International Association for the Study of the Liver. 2008;28(5):705-12.
60. Batash S, Khaykis I, Raicht RF, Bini EJ. High prevalence of hepatitis C virus infection among immigrants from the former Soviet Union in the New York City metropolitan area: results of a community-based screening program. The American journal of gastroenterology. 2008;103(4):922-7.
61. Campello C, Poli A, Dal MG, Besozzi-Valentini F. Seroprevalence, viremia and genotype distribution of hepatitis C virus: a community-based population study in northern Italy. Infection. 2002;30(1):7-12.
62. Goetz AM, Ndimbie OK, Wagener MM, Muder RR. Prevalence of hepatitis C infection in health care workers affiliated with a liver transplant center. Transplantation. 1995;59(7):990-4.
63. Fagundes GD, Bonazza V, Ceretta LB, Back AJ, Bettiol J. Detection of the Hepatitis C virus in a population of adults. Revista latino-americana de enfermagem. 2008;16(3):396-400.
64. Defossez G, Verneau A, Ingrand I, Silvain C, Ingrand P, Beauchant M, Poitou-Charentes Hepatitis C Network. Evaluation of the French national plan to promote screening and early management of viral hepatitis C, between 1997 and 2003: a comparative cross-sectional study in Poitou-Charentes region. European journal of gastroenterology & hepatology. 2008;20(5):367-72.
65. Alexanian AA, Oleszkiewicz GM, Al-Chalabi T, Atabani S, Muir D, Tudor-Williams G, Brown AS. Observational outcomes in a cohort of women identified as hepatitis C (HCV) antibody positive during routine antenatal clinic (ANC) screening. 60th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting; Boston, MA, United States. Published in: Hepatology. 2009;:669A.
66. Zuniga IA, Chen JJ, Lane DS, Allmer J, Jimenez-Lucho VE. Analysis of a hepatitis C screening programme for US veterans. Epidemiology and infection. 2006;134(2):249-57.
67. Fischer LR, Conboy KS, Tope DH, Shewmake DK. Educating health professionals: a hepatitis C educational program in a health maintenance organization. The American journal of managed care. 2000;6(9):1029-36.
68. Grebely J, Knight E, Genoway KA, Viljoen M, Khara M, Elliott D, Gallagher L, Storms M, Raffa JD, DeVlaming S, Duncan F, Conway B. Optimizing assessment and treatment for hepatitis C virus infection in illicit drug users: a novel model incorporating multidisciplinary care and peer support. European journal of gastroenterology & hepatology. 2010;22(3):270-7.
69. Lewis, H., Burke, K., Begum, S., Ushiro-Limb, I., Foster, G.. 903 WHAT IS THE BEST METHOD OF CASE FINDING FOR CHRONIC VIRAL HEPATITIS IN AT-RISK MIGRANT COMMUNITIES?. Journal of Hepatology. 2012;56:S351.
70. Harris KA, Arnsten JH, Litwin AH. Successful integration of hepatitis C evaluation and treatment services with methadone maintenance. Journal of addiction medicine. 2010;4(1):20-6.
71. Bellentani S, Tiribelli C, Saccoccio G, Sodde M, Fratti N, De Martin C, Cristianini G. Prevalence of chronic liver disease in the general population of northern Italy: the Dionysos Study. Hepatology (Baltimore, Md.). 1994;20(6):1442-9.
72. Helsper CW, van Essen GA, Bonten MJ, de Wit NJ. A support programme for primary care leads to substantial improvements in the effectiveness of a public hepatitis C campaign. Family practice. 2010;27(3):328-32.
73. Hayashi J, Kishihara Y, Yamaji K, Yoshimura E, Kawakami Y, Akazawa K, Kashiwagi S. Transmission of hepatitis C virus by health care workers in a rural area of Japan. The American journal of gastroenterology. 1995;90(5):794-9.
74. Thomas DL, Factor SH, Kelen GD, Washington AS, Taylor E, Quinn TC. Viral hepatitis in health care personnel at The Johns Hopkins Hospital. The seroprevalence of and risk factors for hepatitis B virus and hepatitis C virus infection. Archives of internal medicine. 1993;153(14):1705-12.
75. D’Souza RF, Glynn MJ, Alstead E, Foster GR, Ushiro-Lumb I. Improving hepatitis C services across the UK: response to a walk-in HCV testing service. Gut. 2004;53(9):1388.
76. Rainey, J., Robbins, L., Matthews, S., Elphingstone, J., et al. An evaluation of the Florida Department of Health hepatitis programme. Conway, University of Central Arkansas. 2005;
77. Cullen BL, Hutchinson SJ, Cameron SO, Anderson E, Ahmed S, Spence E, Mills PR, Mandeville R, Forrest E, Washington M, Wong R, Fox R, Goldberg DJ. Identifying former injecting drug users infected with hepatitis C: an evaluation of a general practice-based case-finding intervention. Journal of public health (Oxford, England). 2012;34(1):14-23.
78. Alswaidi FM, O’Brien SJ. Is there a need to include HIV, HBV and HCV viruses in the Saudi premarital screening program on the basis of their prevalence and transmission risk factors?. Journal of epidemiology and community health. 2010;64(11):989-97.
79. Surjadi M, Torruellas C, Ayala C, Yee HF, Khalili M. Formal patient education improves patient knowledge of hepatitis C in vulnerable populations. Digestive diseases and sciences. 2011;56(1):213-9.
80. Winter RJ, White B, Kinner SA, Stoové M, Guy R, Hellard ME. A nurse-led intervention improved blood-borne virus testing and vaccination in Victorian prisons. Australian and New Zealand journal of public health. 2016;40(6):592-594.
81. McGinn T, O’Connor-Moore N, Alfandre D, Gardenier D, Wisnivesky J. Validation of a hepatitis C screening tool in primary care. Archives of internal medicine. 2008;168(18):2009-13.
82. Tait JM, McIntyre PG, McLeod S, Nathwani D, Dillon JF. The impact of a managed care network on attendance, follow-up and treatment at a hepatitis C specialist centre. Journal of viral hepatitis. 2010;17(10):698-704.
83. Garrard J, Choudary V, Groom H, Dieperink E, Willenbring ML, Durfee JM, Ho SB. Organizational change in management of hepatitis C: evaluation of a CME program. The Journal of continuing education in the health professions. 2006;26(2):145-60.
84. Jimenez FP, Fuentes HM, Borbolla Busquet E. [Anti-HCV in patients transfused, in a health area attended by a family physician. Medical Office 19 de Abril]. Acta gastroenterologica Latinoamericana. 2000;30(2):99-105.
85. Panlilio AL, Shapiro CN, Schable CA, Mendelson MH, Montecalvo MA, Kunches LM, Perry SW, Edwards JR, Srivastava PU, Culver DH. Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons. Serosurvey Study Group. Journal of the American College of Surgeons. 1995;180(1):16-24.
86. Monnet E, Mercet P, Woronoff-Lemsi MC, Bresson-Hadni S, Pruniaux J, Cottray P, Bouiller C, Allemand H, Miguet JP. [Organized hepatitis C screening. Results and cost of a one-year campaign in a pilot area]. Gastroentérologie clinique et biologique. 2000;24(5):541-6.
87. Gershon RR, Vlahov D, Farzadegan H, Alter MJ. Occupational risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infections among funeral service practitioners in Maryland. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 1995;16(4):194-7.
88. Zdanuk S, Gimpel J, Uhanova J, Kaita KD, Minuk GY. The impact of medical informatics on the confidence of rural physicians caring for patients with chronic hepatitis C viral infections. Family practice. 2001;18(6):602-4.
89. Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology (Baltimore, Md.). 2001;33(1):196-200.
90. Aslam M, Aslam J. Seroprevalence of the antibody to hepatitis C in select groups in the Punjab region of Pakistan. Journal of clinical gastroenterology. 2001;33(5):407-11.
91. Gunewardene R, Lampe L, Ilchef R. Prevalence of hepatitis C in two inpatient psychiatry populations. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists. 2010;18(4):330-4.
92. Zuure F, Davidovich U, Kok G, Depla AC, Hoebe C, van den Hoek A, Jansen PL, van Leeuwen-Gilbert P, Weegink CJ, Coutinho RA, Prins M. Evaluation of a risk assessment questionnaire to assist hepatitis C screening in the general population. Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 2010;15(15):19539.
93. Upfal MJ, Naylor P, Mutchnick MM. Hepatitis C screening and prevalence among urban public safety workers. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 2001;43(4):402-11.
94. McLeod A, Weir A, Aitken C, Gunson R, Templeton K, Molyneaux P, McIntyre P, McDonald S, Goldberg D, Hutchinson S. Rise in testing and diagnosis associated with Scotland’s Action Plan on Hepatitis C and introduction of dried blood spot testing. Journal of epidemiology and community health. 2014;68(12):1182-8.
95. Gunn RA, Murray PJ, Brennan CH, Callahan DB, Alter MJ, Margolis HS. Evaluation of screening criteria to identify persons with hepatitis C virus infection among sexually transmitted disease clinic clients: results from the San Diego Viral Hepatitis Integration Project. Sexually transmitted diseases. 2003;30(4):340-4.
96. Ward C, Tudor-Williams G, Cotzias T, Hargreaves S, Regan L, Foster GR. Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing. Gut. 2000;47(2):277-80.
97. Kallman JB, Tran S, Arsalla A, Haddad D, Stepanova M, Fang Y, Wrobel VJ, Srishord M, Younossi ZM. Vietnamese community screening for hepatitis B virus and hepatitis C virus. Journal of viral hepatitis. 2011;18(1):70-6.
98. Atwell TD, Smith RL, Hesley GK, Callstrom MR, Schleck CD, Harmsen WS, Charboneau JW, Welch TJ. Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. AJR. American journal of roentgenology. 2010;194(3):784-9.
99. Huang JF, Hsieh MY, Dai CY, Hou NJ, Lee LP, Lin ZY, Chen SC, Wang LY, Hsieh MY, Chang WY, Yu ML, Chuang WL. The incidence and risks of liver biopsy in non-cirrhotic patients: An evaluation of 3806 biopsies. Gut. 2007;56(5):736-7.
100. Josset V, Torre JP, Tavolacci MP, Van Rossem-Magnani V, Anselme K, Merle V, Godart J, Libert A, Ladner J, Czernichow P. Efficiency of hepatitis C virus screening strategies in general practice. Gastroentérologie clinique et biologique. 2004;28(4):351-7.
101. Plard C, Shelly M, Millot J, Segouin C, Bertrand D, Le Divenah A. [Anonymous and free screenings: population comparison between those conducted on-site in a testing centre and those done off-site]. Santé publique (Vandoeuvre-lès-Nancy, France). 2007;19(5):355-62.
102. Cohen DE, Russell CJ, Golub SA, Mayer KH. Prevalence of hepatitis C virus infection among men who have sex with men at a Boston community health center and its association with markers of high-risk behavior. AIDS patient care and STDs. 2006;20(8):557-64.
103. Rifai MA, Moles JK, Lehman LP, Van der Linden BJ. Hepatitis C screening and treatment outcomes in patients with substance use/dependence disorders. Psychosomatics. 2006;47(2):112-21.
104. Stockman LJ, Greer J, Holzmacher R, Dittmann B, Hoftiezer SA, Alsum LE, Prieve A, Westergaard RP, Guilfoyle SM, Vergeront JM. Performance of Risk-Based and Birth-Cohort Strategies for Identifying Hepatitis C Virus Infection Among People Entering Prison, Wisconsin, 2014. Public health reports (Washington, D.C. : 1974). 2016;131(4):544-51.
105. Stein K, Dalziel K, Walker A, Jenkins B, Round A, Royle P. Screening for hepatitis C in genito-urinary medicine clinics: a cost utility analysis. Journal of hepatology. 2003;39(5):814-25.
106. Brewer DD, Hagan H. Evaluation of a patient referral contact tracing programme for hepatitis B and C virus infection in drug injectors. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2009;14(14):5-9.
107. Leikin EL, Reinus JF, Schmell E, Tejani N. Epidemiologic predictors of hepatitis C virus infection in pregnant women. Obstetrics and gynecology. 1994;84(4):529-34.
108. Nguyen MT, Herrine SK, Laine CA, Ruth K, Weinberg DS. Description of a new hepatitis C risk assessment tool. Archives of internal medicine. 2005;165(17):2013-8.
109. Lu SN, Chen HC, Tang CM, Wu MH, Yu ML, Chuang WL, Lu CF, Chang WY, Chen CJ. Prevalence and manifestations of hepatitis C seropositivity in children in an endemic area. The Pediatric infectious disease journal. 1998;17(2):142-5.
110. Heseltine G, McFarlane J. Texas statewide hepatitis C counseling and testing, 2000-2005. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:6-11.
111. Pauti MD, Simonnot N, Estecahandy P. [Development of prevention programmes for HIV, hepatitis and sexually transmitted infections among migrants consulting in the doctors of the World French centers]. Médecine et maladies infectieuses. 2008;38(9):495-9.
112. West J, Card TR. Reduced mortality rates following elective percutaneous liver biopsies. Gastroenterology. 2010;139(4):1230-7.
113. Sutton, A. Protecting Injecting Drug Users against Blood-Borne Viruses: Modelling the impact of prison-based interventions. University of Warwick. 2006;
114. Kaur S, Rybicki L, Bacon BR, Gollan JL, Rustgi VK, Carey WD. Performance characteristics and results of a large-scale screening program for viral hepatitis and risk factors associated with exposure to viral hepatitis B and C: results of the National Hepatitis Screening Survey. National Hepatitis Surveillance Group. Hepatology (Baltimore, Md.). 1996;24(5):979-86.
115. Mapagu MC, Martin SJ, Currie MJ, Bowden FJ. Screening for hepatitis C in sexual health clinic attendees. Sexual health. 2008;5(1):73-6.
116. Ellks R. Hepatitis C testing should be performed routinely in all patients attending sexual health services. 2nd Joint Conference of the British HIV Association and the British Association for Sexual Health and HIV Manchester United Kingdom. Published in: HIV Med. 2010;:59.
117. Grebely J, Genoway K, Khara M, Duncan F, Viljoen M, Elliott D, Raffa JD, DeVlaming S, Conway B. Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepatitis C virus infection. The International journal on drug policy. 2007;18(5):437-43.
118. Lindenburg CE, Lambers FA, Urbanus AT, Schinkel J, Jansen PL, Krol A, Casteelen G, van Santen G, van den Berg CH, Coutinho RA, Prins M, Weegink CJ. Hepatitis C testing and treatment among active drug users in Amsterdam: results from the DUTCH-C project. European journal of gastroenterology & hepatology. 2011;23(1):23-31.
119. Hennessy RR, Weisfuse IB, Schlanger K. Does integrating viral hepatitis services into a public STD clinic attract injection drug users for care?. Public health reports (Washington, D.C. : 1974). 2007;122 Suppl 2:31-5.

Búsqueda y Síntesis de Evidencia

Búsqueda y síntesis de evidencia de efectos deseables e indeseables

4.- ¿Cuál es la certeza general de la evidencia sobre efectos?

Muy baja	Baja	Moderada	Alta	Ningún estudio incluido

Baja: Existe incertidumbre de que la evidencia identificada es suficiente para apoyar una recomendación determinada, dado que existen pocos estudios o estos tienen limitaciones.

Evidencia de investigación

Desenlaces	Importancia	Certeza en la evidencia (GRADE)
Mortalidad	CRÍTICO	⨁⨁◯◯ BAJA^a
Calidad de Vida	IMPORTANTE	–
Morbilidad asociada a hepatitis C	CRÍTICO	⨁⨁◯◯ BAJA^b,c
Aceptabilidad del test	IMPORTANTE	⨁◯◯◯ MUY BAJA^a
Derivación a atención médica	IMPORTANTE	⨁◯◯◯ MUY BAJA^c,d,e
Biopsia de higado	CRÍTICO	⨁⨁⨁⨁ ALTA

a. Se disminuyó dos niveles de certeza de evidencia por imprecisión, ya que es estudio único con bajo tamaño muestral para predecir la mortalidad y satisfacción.
b. Se disminuyó un nivel de certeza de evidencia por ser indirecta, ya que los desenlaces reportados corresponden a desenlaces sustitutos de morbilidad asociada a hepatitis C.
c. Se disminuyó un nivel de certeza de evidencia por imprecisión, ya que cada extremo del intervalo de confianza conlleva una decisión diferente
d. Se disminuyó un nivel de certeza de evidencia por riesgo de sesgo ya que en uno de los ensayos [10] no está claro el ocultamiento de la secuencia aleatoria. Además, el ensayo no fue ciego.
e. Se disminuyó un nivel de certeza de la evidencia por inconsistencia, debido a que se observó heterogeneidad significativa entre los estudios (I2=71%)

5.- ¿Hay incertidumbre importante o variabilidad sobre qué tanto valora la gente los desenlaces principales?

Variabilidad importantes	Posiblemente hay incertidumbre o variabilidad importantes	Probablemente no hay incertidumbre ni variabilidad importantes	No hay variabilidad o incertidumbre importante

No hay variabilidad importante: Tomando en cuenta la evidencia identificada, la experiencia clínica y la vivencia de las personas con el problema de salud, el equipo elaborador de la guía consideró que no existe variabilidad importante en como las personas, correctamente informadas, valoran los efectos deseables e indeseables de «realizar test de tamizaje (IgG)».

Evidencia de investigación

• En un estudio de focus group realizado en Irlanda con población penal, hombres y mujeres (n=46), reclutados por invitación abierta. Identificaron la falta de conocimiento como un obstáculo importante para el compromiso con los servicios de tratamiento del VHC. Otras de las barreras identificadas fueron: confidencialidad, miedo a ser estigmatizados. La mayoría de los reclusos consideraban que la detección al momento de ser internados, permitía el tratamiento y lo describía como «más privado» y «más adecuado». Algunos también propusieron un tipo de exclusión voluntaria del programa de detección. [1]
• En otro estudio realizado en una prisión en California, para evaluar la realización de tests de detección del VIH y el virus de la hepatitis C (VHC) sobre una base de «exclusión voluntaria» o «inclusión voluntaria», la mayoría (19) favoreció la opción de inclusión voluntaria, aproximadamente un cuarto (7) prefería la opción de exclusión voluntaria, y el resto (4) no tenía preferencia. [2]
• En un estudio realizado en 81 pacientes nacidos entre 1945-1965, realizado en un servicio de urgencia de un hospital en el área metropolitana de EEUU (3), encuestados mediante una entrevista semiestructurada, se observó que 51 pacientes o casi dos tercios de los entrevistados (63%) consideraron que las pruebas de VHC en el servicio de urgencias eran aceptables y aceptarían someterse a pruebas de detección de VHC en los servicios de urgencias. [3]
• En otro estudio, donde se realizaron 14 focus groups de hombres y mujeres usuarios de drogas afroamericanos o latinos (N = 95), en Nueva York y San Francisco, la mayoría informó que no conocía los sitios de pruebas voluntarias y estaban ansiosos por tener acceso a las pruebas voluntarias de VHC.[4]
• Otro estudio realizado en 25 hombres y 5 mujeres, prisioneros, con historial de uso de drogas de abuso inyectables; Se identificaron barreras personales e institucionales para la realización de test para detectar VHC. Las barreras personales incluyeron: los temores de los presos y la falta de conocimiento sobre el VHC, la baja motivación para realizar el test, la falta de conciencia sobre el procedimiento de prueba y las preocupaciones sobre la confidencialidad y el estigma.[5]
• En otro estudio, realizado en 20 mujeres usuarias de drogas de abuso endovenosa, del estado de Rhode Island, USA, mediante entrevistas semi-estructuradas, se identificaron los siguientes temas relacionados a la realización del test de VHC: priorización de la obtención de la droga que en atender necesidades de salud, bajo nivel de conocimiento, estigmatización, acceso. [6]
• En un estudio realizado en 2005, con 153 prisioneros, hombres y mujeres de una cárcel de Rhode Island; observó que el 91% de los reclusos dijeron que aceptarían hacerse la prueba de hepatitis C y el 95% dijeron que estarían dispuestos a recibir tratamiento para la hepatitis C mientras estaban encarcelados. [7]

Referencias

1. Des Crowley , Marie Claire Van Hout, John S. Lambert, “Barriers and facilitators to hepatitis C (HCV) screening and treatment—a description of prisoners’ perspective”, Harm Reduction Journal (2018) 15:62.
2. Wilson Ly, Jennifer Cocohoba, Alexander Chyorny, “Perspectives on Integrated HIV and Hepatitis C Virus Testing Among Persons Entering a Northern California Jail: A Pilot Study”, J Acquir Immune Defic Syndr, Volume 78, Number 2, June 1, 2018.
3. Waridibo E. Allison, William Chiang, Ada Rubin, “Knowledge about hepatitis c virus infection and acceptability of testing in the 1945–1965 birth cohort (baby boomers) presenting to a large urban emergency department: a pilot study”, The Journal of Emergency Medicine, Vol. 50, No. 6, pp. 825–831, 2016.
4. Ashly E Jordan, Carmen L Masson, Pedro Mateu-Gelabert, “Perceptions of drug users regarding Hepatitis C screening and care: a qualitative study”, Harm Reduction Journal 2013, 10:10.
5. Michelle A. Lally, Sydney A. Montstream-Quas, Sara Tanaka, “A Qualitative Study Among Injection Drug Using Women in Rhode Island: Attitudes Toward Testing, Treatment, and Vaccination for Hepatitis and HIV”, AIDS Patient Care STDS. 2008 January; 22(1): 53–64.
6. Fu-Meng Khaw, Lynne Stobbart, Madeleine J Murtagh, “I just keep thinking I haven’t got it because I’m not yellow’: a qualitative study of the factors that influence the uptake of Hepatitis C testing by prisoners”, BMC Public Health 2007, 7:98.
7. S. Vallabhaneni, G. E.Macalino, S. E. Reinert, “Prisoners favour hepatitis C testing and treatment”, Epidemiol. Infect. (2006), 134, 243–248.

Búsqueda y Síntesis de Evidencia

Búsqueda y síntesis de evidencia de valores y preferencias de los pacientes

6.- El balance entre efectos deseables e indeseables favorece la intervención o la comparación?

Favorece la comparación	Probablemente favorece la comparación	No favorece la intervención ni la comparación	Probablemente favorece la intervención	Favorece la intervención	Varía	No lo sé

Favorece la intervención: Tomando en cuenta la magnitud de los efectos deseables e indeseables, asi como los valores y preferencias de las personas, el equipo elaborador de la guía consideró que «realizar test de tamizaje (IgG)» es la mejor alternativa».

7.- ¿Qué tan grandes son los recursos necesarios (costos)?

Costos extensos	Costos moderados	Costos y ahorros pequeños	Ahorros moderados	Ahorros extensos	Varía	No lo sé

Costos y ahorros pequeños: La diferencia del costo o ahorros entre » realizar test de tamizaje (IgG)» y » no hacer» es inferior a $674.672. Por lo cual el equipo elaborador de la guía consideró que implementar »realizar test de tamizaje (IgG)» no significaría un cambio importante en el gasto o ahorro del sistema de salud.

Evidencia de investigación

Ítem	Precio de realizar screening (IgG)
Virus hepatitis C, anticuerpos de (anti HCV)	$11.230
Total	$11.230

Tabla N° 1 Precios referenciales

Fuente: Arancel FONASA Modalidad Libre Elección Nivel 3

Búsqueda y Síntesis de Evidencia

Informe de costos referenciales

8.- ¿La costo-efectividad de la intervención beneficia la intervención o la comparación?

Favorece la comparación	Probablemente favorece la comparación	No favorece la intervención ni la comparación	Probablemente favorece la intervención	Favorece la intervención	Varía	Ningún estudio incluido

Favorece la intervención: Tomando en cuenta la evidencia identificada y la experiencia clinica, el equipo elaborador de la guía consideró que »realizar test de tamizaje (IgG)» es la opción más costo-efectiva.

Referencias

1. Schackman, B. R., Gutkind, S., Morgan, J. R., Leff, J. A., Behrends, C. N., Delucchi, K. L., Linas, B. P. et al (2018). Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs. Drug and alcohol dependence, 185, 411-420.
2. Selvapatt N., Ward T., Harrison L., Lombardini J., Thursz M., McEwan P., Brown A. The cost impact of outreach testing and treatment for hepatitis C in an urban Drug Treatment Unit. Liver Int. [Internet]. 01 Mar 2017 37(3):345-353.
3. Helsper, C. W., Borkent-Raven, B. A., De Wit, N. J., Van Essen, G. A., Bonten, M. J. M., Hoepelman, A. I. M., De Wit, G. A. et al. (2012). Cost-effectiveness of targeted screening for hepatitis C in The Netherlands. Epidemiology & Infection, 140(1), 58-69.
4. Tramarin, A., Gennaro, N., Compostella, F. A., Gallo, C., Wendelaar Bonga, L. J., & Postma, M. J. (2008). HCV Screening to Enable Early Treatment of Hepatitis C: A athematical Model to Analyse Costs and Outcomes in Two Populations. Current pharmaceutical design, 14(17), 1655-1660.
5. Castelnuovo E, Thompson-Coon J, Pitt M, Cramp M, Siebert U, Price A, Stein K. The cost-effectiveness of testing for hepatitis C in former injecting drug users. Health Technol Assess. 2006;10:iii–xii.
6. Thompson CJ, Castelnuovo E, Pitt M, Cramp M, Siebert U, Stein K. Case finding for hepatitis C in primary care: a cost utility analysis. Fam Pract. 2006;23:393–406. doi: 10.1093/fampra/cml032.
7. Stein, K., Dalziel, K., Walker, A., Jenkins, B., Round, A., Royle, P. (2004). Screening for Hepatitis C in injecting drug users: a cost utility analysis. Journal of Public Health, 26(1), 61-71.
8. Ethgen O, Sanchez Gonzalez Y, Jeanblanc G, Duguet A, Misurski D, Juday T. Public health impact of comprehensive hepatitis C screening and treatment in the French baby-boomer population. J Med Econ. 2017 Feb;20(2):162-170
9. Wong, W. W., Tu, H. A., Feld, J. J., Wong, T., & Krahn, M. (2015). Cost-effectiveness of screening for hepatitis C in Canada. Cmaj, 187(3), E110-E121.
10. Rein, D. B., Smith, B. D., Wittenborn, J. S., Lesesne, S. B., Wagner, L. D., Roblin, D. W., Weinbaum, C. M. et al. (2012). The cost-effectiveness of birth-cohort screening for hepatitis C antibody in US primary care settings. Annals of internal medicine, 156(4), 263-270.
11. Selvapatt, N., Ward, T., Bailey, H., Bennett, H., Thorne, C., See, L. M., Brown, A. et al.(2015). Is antenatal screening for hepatitis C virus cost-effective? A decade’s experience at a London centre. Journal of hepatology, 63(4), 797-804.
12. Urbanus, A. T., van Keep, M., Matser, A. A., Rozenbaum, M. H., Weegink, C. J., van den Hoek, A., Postma, M. J et al. (2013). Is adding HCV screening to the antenatal national screening program in Amsterdam, the Netherlands, cost-effective?. PLoS One, 8(8), e70319.
13. Plunkett, B. A., & Grobman, W. A. (2005). Routine hepatitis C virus screening in pregnancy: a cost-effectiveness analysis. American journal of obstetrics and gynecology, 192(4), 1153-1161.
14. Nakamura J, Terajima K, Aoyagi Y, Akazawa K. Cost-effectiveness of the national screening program for hepatitis C virus in the general population and the high-risk groups. Tohoku J Exp Med. 2008 May;215(1):33-42. PubMed PMID: 18509233.
15. Loubiere, S., Rotily, M., & Moatti, J. P. (2003). Prevention could be less cost-effective than cure: the case of hepatitis C screening policies in France. International journal of technology assessment in health care, 19(4), 632-645.
16. Sutton, A. J., Edmunds, W. J., Sweeting, M. J., & Gill, O. N. (2008). The cost‐effectiveness of screening and treatment for hepatitis C in prisons in England and Wales: a cost‐utility analysis. Journal of viral hepatitis, 15(11), 797-808.
17. Sutton AJ, Edmunds WJ, Gill ON. Estimating the cost-effectiveness of detecting cases of chronic hepatitis C infection on reception into prison. BMC Public Health. 2006 Jun 27;6:170. PubMed PMID: 16803622; PubMed Central PMCID: PMC1543636.

Búsqueda y Síntesis de Evidencia

Informe de búsqueda y síntesis de costo-efectividad

9.- ¿Cuál sería el impacto en equidad en salud?

Reducido	Probablemente reducido	Probablemente ningún impacto	Probablemente aumentado	Aumentado	Varía	No lo sé

Aumentado: El equipo elaborador de la guía consideró que la equidad en salud aumentaría si se recomendase »realizar test de tamizaje (IgG)» , dado que en la actualidad existe acceso a ella, pero es una intervención que habitualmente no se utiliza en poblaciones desaventajadas.

10.- ¿La intervención es aceptable para las partes interesadas?

No	Probablemente no	Probablemente sí	Sí	Varía	No lo sé

Sí: El equipo elaborador de la guía consideró que »realizar test de tamizaje (IgG)» sÍ es aceptable para las partes interesadas (profesionales de la salud, gestores de centros de salud, directivos de centros de salud, pacientes, cuidadores, seguros de salud, otros).

11.- ¿Es factible implementar la intervención?

No	Probablemente no	Probablemente sí	Sí	Varía	No lo sé

Sí: Tomando en cuenta la capacidad de la red asistencial y los recursos humanos y materiales disponibles, el equipo elaborador de la guía consideró que SI es factible implementar »realizar test de tamizaje (IgG)» .

Problema de Salud AUGE N°69

Manejo y tratamiento de la Infección Crónica por Virus de la Hepatitis C (VHC)