Re-appraisal of large-scale community-based hepatitis screenings in a township by two non-government organizations

• Main Authors: Yu-Ju Chen, 陳郁筑
• Other Authors: Ming-Hong Yen
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/fp5a2s

碩士 === 高雄醫學大學 === 藥學系碩士在職專班 === 106 === Background: Outcomes of Hepatitis B prevention and control in Taiwan is outstanding in the world. Hepatitis B, significant efforts have also been devoted to the prevention and control of Hepatitis C, including reimbursement of oral direct-acting antiviral drugs by the National Health Insurance. DAA can block disease progression for patients with chronic Hepatitis C infection. In Taiwan, screening by liver-related foundations has been widely known under the spread of newspaper media, and also believed by some to be a good screening model. In this study, we re-appraised this screening model from the epidemiological and clinical perspectives. Aims: To retrospectively analyze community-based screening data and discuss the effectiveness and unresolved issues of large-scale community screening from clinical perspectives. Methods: Two non-governmental organizations conducted a two-stage liver cancer screening in Daliao District, Kaohsiung City. The first stage was blood sampling to test HBsAg anti-HCV, AST , ALT and AFP. For those who were positive for HBsAg or anti-HCV, further confirmation were performed on HBV DNA and HCV RNA. The second stage was ultrasonography examination for participants who were positive for any of the above five markers. Results: A total of 1495 subjects participate in this screening. The median coverage rates of 22 villages were 7.93/1000. Overall prevalence of HBsAg and anti-HCV were 11.6% and 3.7%. To identify the candidates of antiviral treatment for chronic Hepatitis B and C virus infection, participants were stratified by viral load and ALT levels. Among the positive subjects, only less than half were positive for HBV DNA (5.3%) or HCV RNA (1.5%). To identify the high risk for HCC by REACH-B risk score, only 16 (9.2%) of HBsAg carrier were with score higher than 10. Five subjects had AFP levels higher than 20 ng/ml. Discussion: In the study area with same prevalence of HBsAg and anti-HCV as the whole of Taiwan, we found that only few candidates for anti-viral treatment or HCC screening can be detected through such a community-based screening. We noted that geographic representation of participants to the whole population was poor. Conclusion: Due to biased geographic sampling and low rate of candidates for intervention, community-based screening should be conducted with well-coverage design in high risk areas.