Abstract
BackgroundIdentifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals.MethodsThis cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography.ResultsThe prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication.ConclusionsThe prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis.Trial registrationResearch Ethics Committee of the Faculty of Health Sciences of the University of Brasília - UNB (CAAE number 77818317.2.0000.0030) and by the Ethics Committee of the Health Science Teaching and Research Foundation - FEPECS/SES/DF (CAAE number 77818317.2.3001.5553).
Highlights
Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection
Since we have examined a large population distributed throughout the Brasilia, Federal District, Brazil, we decided to estimate the prevalence of positive anti-HCV serology by rapid test (RT) in these subjects
Estimated prevalence at the Federal District Overall, 62,449 RTs were conducted as screening tests for hepatitis C in individuals aged > 40 years
Summary
Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. A strategic plan has been outlined recently to address HCV infection in Brazil It comprises incorporating new, effective, affordable drugs guiding physicians in treating HCV patients, and promoting diagnostic campaigns in populations aged > 40 years, as recent studies have shown a higher prevalence of infection [8, 12, 13]. It is postulated that the HCV prevalence in Brazil increased with age and is higher in adults born between 1950 and 1980, with genotype 1 most prevalent of chronic infections [6, 13, 14] These studies confirmed Brazil as a country with low endemicity for hepatitis C
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