Hepatitis B and hepatitis C are primarily viral infections transmitted through the blood, which – often unnoticed – become chronic and can irreversibly damage the liver. It is discussed whether regular examination of the general population or individual risk groups could limit these diseases, for example through early identification and treatment or altered risk behavior for those affected. However, screening can also have flaws, such as causing fears.
In hepatitis B and C, use for those affected or overcoming the potential populations for the general population? The Institute for Quality and Efficiency in Health (IKViG) systematically deals with these issues. In May 2018 he published two preliminary reports and put them to a discussion. After evaluation of the received comments, the Institute is now presenting the final reports. Main result: Lack of significant evidence, the benefit-benefit ratio of screening for hepatitis B and hepatitis C remains unclear.
Modeling studies on the risk group screening
IKViG also studied current modeling studies. Models differ in their structure, assumptions, modeled time periods, identified effects and intended interventions – such as the introduction of systematic screening, increased treatment rates, and the improvement of preventive measures such as syringe programs.
The relative proportions of these possible measures remain unclear in reducing new hepatitis C infections. Screening that does not reach a nearly complete risk group can weaken the effect, as well as a treatment break or repeated infection after the therapy. The question of the extent to which the assumptions used in these models apply to the context of the German contingent remains to a great extent open.
However, modeling studies suggest that screening for injecting injection users can significantly reduce the long-term prevalence of hepatitis C if the infected is later treated and received treatment to prevent the spread of the infection.
Recommendation recommendations for hepatitis C plausible
In addition to the studies, IKViG also assessed the current guidelines. Recommendations for the screening of risk groups for hepatitis B are based on assumptions that are incomprehensible.
On the other hand, some hepatitis C guidelines yield credible assumptions about the possible advantages and disadvantages of screening for at-risk groups and specific cohorts of the births and, therefore, oppose the projection of hepatitis C limited to these groups. If such a review of risk groups for hepatitis C is introduced, the follow-up evaluation would be important in order to reduce the presented ambiguity and, if necessary, quickly change the program.
Requirements for the follow-up evaluation
The central registration of all persons participating in screening and complete monitoring. It is also necessary to assess the percentage of the group at risk who actually took part in screening.
Among other things, the number of liver biopsies, antiviral therapies that have been started, therapies that are fully completed, adverse effects and those with sustained virological response should be assessed. At least one random sample should also cover the health quality of life in years after the test or start of treatment. The rate of reinfection and the reasons for re-infection should also be determined.
Whether and how much screening and subsequent treatment actually reduce the prevalence of hepatitis C, it is easiest to determine if there is a control group. To this end, a systematic review of the risk group could initially be introduced in individual pilot areas, and data from other regions could be used for comparison.