HEPATITIS C SCREENING in ADULTS with RISK FACTORS in FIVE CITIES of COLOMBIA'S CARIBBEAN COAST (FIVE-CC)

As of 2017, according to a WHO report, only 20% of people with HCV worldwide had been diagnosed (18). Micro- elimination strategies targeting small populations, rather than nationwide elimination programs, have been shown to improve diagnosis and treatment rates, yielding significant benefits for expanding the HCV care cascade and achieving WHO goals (14).

In the general population and the most affected populations, HCV screening recommendations from countries like Spain, the United Kingdom, Germany, France, Ireland, Canada, and Australia include population and opportunistic screening. This involves HCV screening in people exposed to risk factors such as intravenous or inhaled drug use, high-risk sexual behavior, HIV/HBV coinfection, aesthetic procedures involving sharp instruments without proper safety precautions, and imprisonment (17). Anyone who received blood transfusions before serological testing of blood donors for HCV, underwent medical or dental procedures in healthcare settings with substandard infection control practices, is also included.

Risk-based screening recommendations, as opposed to population screening, focus efforts and resources, ensuring equity in the design, implementation, and evaluation of HCV screening programs. These allow for addressing access barriers in each context (17). Targeted screening would identify a high number of infected individuals due to the higher infection rate related to risk factors, while simultaneously reducing viral transmission by eliminating HCV from individuals at higher risk of spreading the infection (20).

The study conducted by Rosato et al. (2022) highlight the need to increase awareness among general practitioners and other healthcare specialists who treat patients with different comorbidities to address HCV disease control. This is important as HCV eradication has been shown to significantly improve not only liver disease outcomes but also various comorbidities such as cryoglobulinemic vasculitis, diabetes, cardiovascular, and kidney diseases, etc. (21).

Monitoring the care cascade (CoC) is an essential component of the global response to the hepatitis C virus (HCV) epidemic. The findings allow healthcare decision-makers to determine where the most significant gaps in testing, care linkage, and treatment exist among people with chronic HCV infection (22).

Micro-elimination strategies in populations at high risk of transmitting HCV may contribute to the concept of "treatment as prevention." This concept involves successfully treating an HCV-infected individual who is at risk of transmitting the virus to others, thereby eliminating the possibility of further transmission, achieving "prevention." Due to its potential to prevent additional infections, many of which would incur high costs for treating end-stage liver disease, this approach could be highly cost-effective in the long term (18).

Targeting those at greatest risk of contracting the disease can generate broader community benefits and long-term cost-effectiveness. Supporting this approach to HCV eradication, model studies conducted by Martin and colleagues (2011 and 2013) have indicated that chronic HCV prevalence could be reduced by treating individuals at risk of continuous HCV transmission (23).

Since 2017, Colombia's High-Cost Account (CAC) has monitored identified chronic hepatitis C cases in accordance with Resolution 1692 of 2017, which is part of the strategy for negotiating and centrally purchasing direct-acting antivirals (24).

The most frequently used treatment in 98.2% of cases in the 2019-2020-2021 cohorts was sofosbuvir/velpatasvir, achieving 98.7% effectiveness in 2021 (25).

However, efforts are needed to incentivize screening in people over 50 years old and according to risk exposure, as established by Resolution 3280 of 2018 (25).

1. Research Question What is the prevalence of HCV in populations with risk factors for hepatitis C infection, detected through rapid testing in five cities on the Caribbean coast of Colombia? 4. Objectives

General Objective:

Determine the prevalence of HCV in patients with HCV risk factors, detected through opportunistic screening in five cities on the Caribbean coast of Colombia.

Specific Objectives:

• Characterize the sociodemographic profile of the study population.
• Describe the epidemiological characteristics of patients with positive HCV antibodies.
• Determine the proportion of patients with positive HCV antibodies and positive (quantitative) viral load for HCV.
• Conduct an exploratory analysis of the association between positive cases and various HCV infection risk factors.

1. Methodology

Study Type:

Descriptive, cross-sectional, multicenter study.