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. 2014 Mar 24;9(3):e92266.
doi: 10.1371/journal.pone.0092266. eCollection 2014.

Current state of and needs for hepatitis B screening: results of a large screening study in a low-prevalent, metropolitan region

Julie Bottero  1 , Anders Boyd  2 , Maud Lemoine  3 , Fabrice Carrat  4 , Joel Gozlan  5 , Anne Collignon  6 , Nicolas Boo  7 , Philippe Dhotte  8 , Brigitte Varsat  9 , Gerard Muller  10 , Olivier Cha  11 , Nadia Valin  12 , Jean Nau  13 , Pauline Campa  12 , Benjamin Silbermann  14 , Marc Bary  15 , Pierre-Marie Girard  1 , Karine Lacombe  1
Affiliations

Current state of and needs for hepatitis B screening: results of a large screening study in a low-prevalent, metropolitan region

Julie Bottero et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Definition of HBV infection status.
Figure 2
Figure 2. CDC recommendations for HBV screening.
Figure 3
Figure 3. Study Flow Diagram.
See this image and copyright information in PMC

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