Public Release: 

Researchers highlight need for better evidence to guide EU efforts to increase hep B+C testing

Review presented at The International Liver CongressTM 2015 documents lack of information about hepatitis B and C testing in many countries

European Association for the Study of the Liver

April 25, 2015, Vienna, Austria: The apparent dearth of research on hepatitis B and C testing in many European countries could be hampering efforts to identify infected individuals, according to results from a comprehensive review of 136 studies presented today at The International Liver CongressTM 2015.

The systematic review concluded that the current evidence base on hepatitis B and C testing appears to be lacking in many European countries. At present it is informed primarily by published articles and conference abstracts from just 6 out of 53 member countries of the World Health Organization (WHO) European Region: Turkey, Germany, Italy, France, the Netherlands and the United Kingdom.

The results indicate that some high-risk populations have been studied much more than others, but mostly only in a small number of countries. The results also appear to show high median testing uptake levels across Europe. However, since almost all of the studies used methodologies that required or encouraged study participants to undergo testing, high median testing uptake levels are not likely to be representative of the overall testing uptake in most populations.

"It's clear from our review that there are crucial gaps in our knowledge on hepatitis B and C testing - we do not yet have enough information to plan effective public health responses in Europe," commented Professor Jeffrey Lazarus, Professor of International Health Systems at Copenhagen University, Denmark. "Our research team is particularly concerned about the low numbers of published studies looking at migrants, prison inmates and men who have sex with men - all populations that might benefit greatly from targeted hepatitis testing interventions."

Professor Tom Hemming Karlsen, Scientific Committee Member, European Association for the Study of the Liver, added: "Viruses that affect the liver, such as hepatitis B and C, can cause real problems if not identified and treated early. We need to raise awareness of the threat posed by these viruses and actively encourage testing across Europe. This is not only vital to diagnosis and treatment but also to prevention - to stopping the viruses spreading through populations and generations to come."

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EU Public Health, Hall C Presentation time: 12:45-13:00 Presenter: Jeffrey Lazarus (Denmark) Abstract O0125: A SYSTEMATIC REVIEW OF HEPATITIS B AND C TESTING IN THE COUNTRIES OF THE WHO EUROPEAN REGION

A SYSTEMATIC REVIEW OF HEPATITIS B AND C TESTING IN THE COUNTRIES OF THE WHO EUROPEAN REGION

Jeffrey V. Lazarus* 1, Ida Sperle1, Jürgen K. Rockstroh2, Alexander Spina3, Lucas Wiessing4 1CHIP, Rigshospitalet, University of Copenhagen, Copenhagen Oe, Denmark, 2Department of Medicine I, University Hospital Bonn, Bonn, Germany, 3Centre for Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria, 4European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal

Background and Aims: Growing awareness of the threat posed by hepatitis B and C has been accompanied by important biomedical advances in their treatment. However, in Europe as elsewhere, there is the potential for hepatitis drugs to be greatly underutilised because many people who might benefit from them are undiagnosed. We reviewed scientific studies reporting hepatitis B and C testing as a step toward informing public health strategies to reduce the number of individuals who remain undiagnosed.

Methods: Using PRISMA criteria, we conducted a systematic review of the MEDLINE and EMBASE databases to identify original research studies reporting levels of hepatitis B and C testing in the 53 Member States of the WHO European Region. English-language peer-reviewed articles and conference abstracts published between January 2007 and June 2013 were included.

Results: This review identified 154 studies from 28 (52.8%) of 53 countries. More than two-thirds of the studies (67.7%) were from six countries: Turkey, Germany, Italy, France, the Netherlands and the United Kingdom. The populations studied most frequently were people who use drugs (32 studies), health care patients (28) and populations tested for reasons relating to pregnancy or use of assisted reproductive technology (18) (Figure 1). Median testing uptake levels ranged from 100% for eight types of populations (Figure 1) to 79.9% for people born to HBsAg-positive mothers and 70.5% for current or former prison inmates. Four studies reported testing uptake of 75.0% or lower in people living with HIV, and six studies reported testing uptake of less than 50% in people who use drugs. The highest median HBsAg prevalence (14.9%) and HCV RNA prevalence (49.7%) were both found in people who use drugs.

Conclusions: An evidence base on hepatitis B and C testing appears to be lacking in many European countries. The results indicate that some high-risk populations have been studied much more than others, but mostly only in a small number of countries. Since almost all studies utilised methodologies that required or encouraged study participants to undergo testing, high median testing uptake levels are not likely to be representative of overall testing uptake in most populations. Low testing uptake in some studies raises the question of whether key opportunities to identify infected individuals are being missed. Public health officials need much more comprehensive information in order to plan effective responses to hepatitis B and hepatitis C in Europe.

Disclosure of Interest: None Declared

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