Beyond Risk Factors: Rethinking Hepatitis B and Hepatitis C Screening in Primary Care

Introduction

Most international guidelines recommend screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) only for individuals with risk factors or elevated ALT levels. However, this approach may not suffice to eradicate viral hepatitis. This study evaluates the application of EASL HBV and HCV screening guidelines in primary care centres (PCCs).

Methods

The study included two components: (1) A retrospective review (January 2021–March 2023) of microbiology data to determine testing rates, analyse clinical characteristics, and assess management; and (2) A prospective intervention (March–April 2024) involving HBV and HCV screening and risk factor surveys for all adults attending two PCCs for blood collection.

Results

In the retrospective analysis of 90 170 patients, HBV and HCV screening rates were 16% and 10%, respectively. Among HBsAg-positive patients (n = 84 (0.5%)), 67% lacked risk factors or elevated ALT. Among anti-HCV-positive (n = 277 (3%)) and HCV RNA-positive (n = 45 (0.5%)) patients, 54% and 46% respectively lacked these indicators.

In the prospective study of 1030 patients (mean age 55, 39.6% men, 73% Spanish), anti-HCV was detected in 1.16% of cases (HCV RNA in 0.19%). Of these, 67% lacked risk factors or elevated ALT. No HBsAg-positive cases were identified, and hepatitis B vaccination status was uncertain for 50% of patients.

Conclusion

Risk factor-based screening for HBV and HCV in primary care is a suboptimal approach. More than half of the patients testing positive lacked identifiable risk factors or elevated ALT levels. Universal one-time screening for all adults could address these limitations and significantly advance viral hepatitis elimination efforts.