Abstract
An estimated 9 million individuals are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) across the European Union/European Economic Area (EU/EEA), many of which are yet to be diagnosed. We performed a systematic review to identify interventions effective at improving testing offer and uptake in the EU/EEA. Original research articles published between 1 January 2008 and 1 September 2017 were retrieved from PubMed and EMBASE. Search strings combined terms for HBV/HCV, intervention, testing and geographic terms (EU/EEA). Out of 8331 records retrieved, 93 studies were selected. Included studies reported on testing initiatives in primary health care (9), hospital (12), other healthcare settings (31) and community settings (41). Testing initiatives targeted population groups such as migrants, drug users, prisoners, pregnant women and the general population. Testing targeted to populations at higher risk yielded high coverage rates in many settings. Implementation of novel testing approaches, including dried blood spot (DBS) testing, was associated with increased coverage in several settings including drug services, pharmacies and STI clinics. Community‐based testing services were effective in reaching populations at higher risk for infection, vulnerable and hard‐to‐reach populations. In conclusion, our review identified several successful testing approaches implemented in healthcare and community settings, including testing approaches targeting groups at higher risk, community‐based testing services and DBS testing. Combining a diverse set of testing opportunities within national testing strategies may lead to higher impact both in terms of testing coverage and in terms of reduction, on the undiagnosed fraction.
Highlights
Across the European Union/European Economic Area (EU/EEA), an estimated 4.7 million people are chronically infected with hepatitis B virus (HBV) and 3.9 million are chronically infected with hepatitis C virus (HCV).[1]
A systematic review covering HBV and HCV testing studies in key populations in the European region until June 2013 found that, a large number of studies on testing existed, these were unevenly distributed across Europe and that large gaps existed in certain key populations including migrants, people in prison and men who have sex with men (MSM).[17]
It is an important setting for testing a number of population groups that may not present to other settings and may be especially important for specific population groups including ex‐people who inject drugs (PWID).[92]
Summary
Across the European Union/European Economic Area (EU/EEA), an estimated 4.7 million people are chronically infected with hepatitis B virus (HBV) and 3.9 million are chronically infected with hepatitis C virus (HCV).[1]. A systematic review covering HBV and HCV testing studies in key populations in the European region until June 2013 found that, a large number of studies on testing existed, these were unevenly distributed across Europe and that large gaps existed in certain key populations including migrants, people in prison and MSM.[17] Previous systematic reviews on testing interventions focused solely on either HBV or HCV,[18,19,20,21,22,23] specific key populations or settings,[19,21,22,24] targeted testing interventions[18,23] or included comparative studies only.[25] a comprehensive report on hepatitis testing policies and activities in EU/EEA countries revealed substantial gaps in testing coverage and testing offers targeting higher risk groups across the region.[8]. This study was conducted as part of a larger project to develop an integrated European testing guidance for HBV, HCV and HIV, coordinated by the European Centre for Disease Prevention and Control (ECDC)
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