1Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
2Inserm UMR-S707, Paris, France.
3Service d'Hépatologie, Hôpital St Antoine, AP-HP, Paris, France.
4Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Unité de Santé Publique, Hôpital St Antoine, AP-HP, Paris, France.
5Laboratoire de Virologie, Hôpital St Antoine, AP-HP, Paris, France.
6Laboratoire St Marcel, Mairie de Paris, Paris, France.
7Direction de l'Action Sociale, de l'Enfance et de la Santé, Mairie de Paris, Paris, France.
8Centre de dépistage anonyme et gratuit (CDAG) du Figuier, Mairie de Paris, Paris, France.
9Département des Examens Périodiques de Santé (DEPS), CPAM de Paris, France.
10CDAG de Belleville, Paris, France.
11Policlinique Baudelaire, Hôpital St Antoine, AP-HP, Paris, France.
12Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
13Centre d'accueil, de soins et d'orientation, Médecins du Monde, Paris, France.
14Unité de consultation et de soins ambulatoires (UCSA), Maison d'arrêt de la santé, Paris, France.
15Centre Croix Rouge du Moulin Joly, Paris, France.
In low hepatitis B virus (HBV)-prevalent countries, most HBV-infected persons are unaware of their status. We aimed to evaluate whether (i) previous HBV-testing, (ii) physicians decision to screen, and (iii) CDC's recommendations identified infected individuals and which risk-factor groups needing testing.
During a mass, multi-center HBV-screening study from September 2010-August 2011, 3929 participants were screened for hepatitis B surface antigen (HBsAg), anti-HBs and anti-Hepatitis B core antibodies (anti-HBcAb). Questions on HBV risk-factors and testing practices were asked to participants, while participants' eligibility for HBV-testing was asked to study medical professionals.
85 (2.2%) participants were HBsAg-positive, while 659 (16.8%) had either resolved HBV infection or isolated anti-HBcAb. When comparing practices, HBV-testing was more likely to occur in HBV-infected participants if Centers for Disease Control and Prevention (CDC) recommendations were used (Sensitivity = 100%, 95%CI: 95.8-100) than physicians' discretion (Sensitivity = 87.1%, 95%CI: 78.0-93.4) or previous HBV-test (Sensitivity = 36.5%, 95%CI: 26.3-47.6) (p<0.0001). Nevertheless, many non-infected individuals would still have been screened using CDC-recommendations (Specificity = 31.1%, 95%CI: 29.6-32.6). Using multivariable logistic regression, HBsAg-positive status was significantly associated with the following: males, originating from high HBV-endemic region, contact with HBV-infected individual, without national healthcare, and intravenous-drug user (IDU). Of these risk-factors, physician's discretion for testing HBV was not significantly associated with participants' geographical origin or IDU.
Missed opportunities of HBV-screening are largely due to underestimating country of origin as a risk-factor. Applying CDC-recommendations could improve HBV-screening, but with the disadvantage of many tests. Further development of HBV-testing strategies is necessary, especially before severe disease occurs.