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and 1&#46;9&#37;&#46; Currently in Spain&#44; the number of people with an active HCV infection could be between 480&#44;000 and 760&#44;000&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">HCV infection is therefore a major health problem&#46; Approximately 20&#37; of people diagnosed with HCV develop cirrhosis in 20 years&#44; and 15&#37; of patients with cirrhosis will develop hepatocellular carcinoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> The cumulative probability of presenting an episode of clinical decompensation is 5&#37; during the first year after a diagnosis of cirrhosis&#44; increasing to 30&#37; after 10 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a> In Spain&#44; HCV infections are the leading cause of liver transplantations&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A significant percentage of people with HCV infection do not know that they are infected and therefore cannot benefit from available treatments and can even unknowingly transmit the disease&#46; The detection of unknown HCV infections in asymptomatic people gives these people the opportunity for pre-emptive treatment before complications can develop&#46; For these reasons&#44; the present study evaluates several strategies to detect unknown cases of HCV in the adult population within primary care&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">This was an observational&#44; prospective and multicenter study&#46; All study participants were over 18 years of age and were distributed over 4 primary care teams &#40;PCTs&#41; in the province of Barcelona &#40;Vilassar de Dalt&#44; Vilassar de Mar&#44; Premi&#224; de Mar and Matar&#243;-6&#41; and in the PCT of Cass&#224; de la Selva and its affiliated clinics &#40;Llagostera&#44; Caldes de Malavella&#44; Riudellots&#44; Quart&#41; belonging to the Healthcare Institute of Girona&#44; Spain&#46; All PCTs in this study cared for people from similar socioeconomic and educational backgrounds&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following strategies for the detection of unknown chronic HCV infection were evaluated&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Strategy 1 or &#8220;universal screening&#8221;&#46; A total of 5793 men and women over 18 years of age were invited to undergo a serological examination for antibodies against HCV&#46; These adults were selected by simple random sampling from the 22&#44;000 patients assigned to the PCTs of Vilassar EAP de Dalt and Vilassar de Mar and sent an informational letter addressing the dangers of HCV infection and the importance of early HCV detection and presymptomatic treatment in order to prevent HCV progression&#46; The letter further explained that those who would like to participate in the study should consult their PCT office for the serological examination&#46; These visits were conducted by specially trained nurses who cared for the patients&#44; explained to them the nature of the study&#44; requested their informed consent and drew their blood&#46; The nurses also requested laboratory determinations of aspartate transaminase&#44; alanine transaminase and HCV-antibody levels&#44; which were measured by chemiluminescence immunoassay &#40;Abbott&#41;&#46; All patients were later informed of the results of their HCV serological examination&#46; For cases with positive HCV serological results&#44; HCV RNA was verified via polymerase chain reaction&#46; If the result was positive&#44; the patient was referred to specialized care to assess appropriate treatment and follow-up care&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Strategy 2 or &#8220;PCT population-specific screening&#8221;&#46; Informational posters were placed in highly visible&#44; strategic locations in and around each PCT office so that patients could easily read them&#46; Informational leaflets were also made available at the PCT office counters&#46; This strategy was assigned to the PCT of Cass&#224; de la Selva and its affiliated clinics&#44; with a total patient population of 20&#44;000 people&#46; In the informational posters and leaflets&#44; the risk factors for HCV infection were explained so that people who thought they might have an HCV infection could enroll in the study&#46; When patients enrolled in the study&#44; the same procedures were followed as previously described in Strategy 1&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Strategy 3 or &#8220;restricted to people with hypertransaminasemia&#8221;&#46; This consisted of identifying patients with hypertransaminasemia and conducting a serological HCV examination for those patients who had not undergone such an examination&#46; This strategy was assigned to the PCTs of Premi&#224; de Mar and Matar&#243;-6&#46; The data collected by the computer system used at these PCTs &#40;e-CAP&#41; were filtered for the codes for increased transaminase levels in the laboratory tests of all adult patients within the past 2 years&#46; Once this list of patients was obtained&#44; it was checked to determine whether they had undergone a previous HCV serological examination&#46; If there had been no such examination&#44; a list with the patients&#8217; names was sent to their family physicians&#44; who then contacted the patients&#44; requested new laboratory tests &#40;which included an HCV serological test&#41; and informed the patients of the results&#46;</p></li></ul></p><p id="par0065" class="elsevierStylePara elsevierViewall">Data collection for Strategies 1 and 2 was the responsibility of the nurses&#44; while for Strategy 3&#44; the data were collected from the patients&#8217; medical histories &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Case report forms were developed to record the following data&#58; demographic variables &#40;gender&#44; age&#44; ethnicity&#44; community&#47;country of origin&#44; and education level&#41;&#44; previous history of liver disease &#40;alcoholic liver disease&#44; hepatitis B&#44; HCV&#44; autoimmune disease&#44; etc&#46;&#41;&#44; alcohol consumption &#40;years of consumption and daily intake&#41;&#44; previous risk factors for HCV infection &#40;blood transfusion&#44; surgery or treatment with anticoagulant factors before 1992&#44; piercings&#44; tattoos&#44; nasal or parenteral drug use&#44; family history&#44; sexual promiscuity&#44; hemodialysis&#44; and nosocomial infections&#41;&#44; transaminase levels and viral serology&#46; The presence of HCV RNA was checked in all patients with positive HCV serology&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The planned sample size was calculated based on the prevalence of positive HCV-antibodies in the general population of Catalonia &#40;2&#46;5&#37;&#41; and an estimated prevalence &#40;&#177;precision&#41; of chronic HCV infection of 2&#46;5&#37; &#40;&#177;1&#46;25&#37;&#41; in the general population&#44; 3&#37; &#40;&#177;1&#46;5&#37;&#41; in the target population and 8&#37; &#40;&#177;4&#37;&#41; in people with high transaminase levels&#46; Taking these prevalence estimates into account&#44; the following number of participants would be needed to ensure the degree of accuracy mentioned earlier&#58; 1153 in Strategy 1&#44; 693 in Strategy 2 and 176 in Strategy 3&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study was approved by the Ethics Committee for Clinical Research of the Jordi Gol IDIAP Foundation&#44; the Hospital Clinic and the Healthcare Institute of Girona&#44; Spain&#46; All participants of this study gave their written informed consent&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study was conducted between March 2010 and May 2011&#46; There were a total of 598 participants &#40;295 men &#91;49&#37;&#93; and 303 women &#91;51&#37;&#93;&#41;&#46; The participants ranged from 20 to 90 years of age&#44; with a mean age of 50&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 years&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The PCTs assigned to Strategy 1 sent out an average of 200 letters a week during the 8-month study period&#44; for a total of 5793 letters&#46; A total of 238 individuals &#40;4&#46;1&#37; participation&#59; 38&#37; men&#59; mean age 48&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2 years&#41; agreed to participate in the study&#46; Only one case was serologically positive for HCV&#44; which was further confirmed as positive for HCV RNA&#46; The infection prevalence of Strategy 1 was 0&#46;4&#37; &#40;95&#37; confidence interval &#91;95&#37; CI&#93; 0&#46;1&#8211;2&#46;3&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In Strategy 2&#44; informational posters and leaflets were posted in PCT offices for a period of 8 months&#46; They recruited 76 participants from 20&#44;000 potential users&#44; although 7 participants did not attend their scheduled appointments to extract blood&#46; Therefore&#44; Strategy 2 was comprised of 69 people &#40;0&#46;3&#37; participation&#59; 26&#37; men&#59; mean age 51&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;9 years&#41;&#46; Only one instance of HCV-antibodies was detected&#44; which was further confirmed as HCV RNA positive&#44; representing an infection prevalence of 1&#46;4&#37; &#40;95&#37; CI 0&#46;3&#8211;7&#46;8&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">For Strategy 3&#44; a total of 480 patients with hypertransaminasemia were identified&#44; 291 of whom had an unknown HCV-antibody status&#46; Of these 291 people&#44; 2 were found to have a positive HCV-antibody serology with detectable HCV RNA &#40;0&#46;7&#37; prevalence&#59; 95&#37; CI 0&#46;2&#8211;2&#46;5&#37;&#41;&#46; Additionally&#44; 10 of the 183 patients with a previous HCV serological examination were positive for HCV &#40;5&#46;3&#37;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study compared the efficiency of three different strategies for detecting occult cases of HCV infection in the general population&#46; The evaluated strategies were based on methods similar to those used effectively for the early detection of breast<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and colorectal cancer&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> as well as for seasonal flu prevention campaigns for at-risk primary care populations&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The results of this study were disappointing&#44; given that the participation rate was very low &#40;4&#46;1&#37; and 0&#46;3&#37;&#41; in Strategies 1 and 2&#46; These strategies took a &#8220;screening&#8221; approach&#44; distributing information that offered the possibility of serological examinations to diagnose occult HCV infection&#46; It should be noted that for Strategy 2 we took the entire population assigned to the PCT as the denominator&#44; although only those individuals who visited the healthcare centers during the study period received the information&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The main limitation of our study was the inexplicable low participation rates of Strategies 1 and 2&#46; The participants&#8217; age and gender distribution were similar to that of the reference population&#46; It could be assumed that people in our community who have no risk factors for HCV infection or symptoms of the disease do not consider the early diagnosis of hepatitis C to be as important as the early detection of breast and colon cancer&#46; The media was not used to raise awareness of our current study&#46; It is possible that the lack of advertisement negatively influenced our results&#44; given that newspaper and local radio campaigns have previously been used to encourage people to participate in studies aimed at early cancer detection&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The results of our study contrast with those of a recent study that used the Internet to diagnose HCV infection in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In this Internet-based study&#44; people with risk factors for HCV infection were invited to fill in an online questionnaire to assess their risk of hepatitis C&#46; High-risk candidates were then offered an anonymous HCV serological examination and&#44; if needed&#44; an individualized clinical evaluation and follow-up treatment&#46; The study had a 28&#37; participation rate&#44; and occult HCV infection was diagnosed in 3&#46;6&#37; of the cases&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The search for occult cases of chronic HCV infection is justified because this disease tends to progress without treatment and because increasingly effective therapies are available to treat the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> The most effective and less expensive method for detecting new cases of occult HCV infection is probably the determination of HCV-antibody status in anyone with high transaminase levels<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and in people at high risk of hepatitis C but who have normal transaminase levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a> Smith et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> suggested systematically performing HCV serological examinations on people born between 1945 and 1964&#44; given that this population has a higher prevalence of HCV infection&#44; which is probably due to the likelihood of having received blood transfusions before 1989 and injections with non-disposable syringes&#46; A high percentage of infected individuals &#40;close to 50&#37;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#41; are unaware that they are infected and consequently can unwittingly contribute to the spread of HCV&#46; Furthermore&#44; their liver disease will continue to progress if they consume alcoholic beverages<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and do not receive antiviral treatment&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The detection of individuals with occult HCV infection is an essential competency for primary care physicians&#44; who should consider this possibility by default in any patient with hypertransaminasemia&#46; Surprisingly&#44; our study showed that HCV screening only occurs in 40&#37; of all these cases&#46; A possible explanation for this could be the physicians&#8217; belief that their patient&#39;s hypertransaminasemia was caused by hepatic steatosis of metabolic origin&#46; This type of hepatic steatosis is the most frequent cause of liver disease in most Western countries&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> especially in patients who have risk factors for fatty liver disease &#40;obesity&#44; dyslipidemia or diabetes mellitus&#41; but no risk factors for hepatitis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In clinical practice&#44; a possible HCV infection should be considered in any patient with persistent hypertransaminasemia&#44; no matter how unlikely&#44; because the benefits of reaching a diagnosis are increasingly evident&#46; Family physicians are in a unique position because they can identify and act upon risk factors that might go unrecognized by patients&#44; allowing an early diagnosis to be made&#46; Family physicians can&#44; in turn&#44; inform patients and their families about the disease&#44; preventive measures and treatment options&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Although the observed prevalence rates of HCV for Strategies 1 and 2 &#40;0&#46;4&#37; and 1&#46;4&#37;&#44; respectively&#41; were lower than expected&#44; the results are consistent with the declining prevalence of this infection in our community&#44; which had a rate of 2&#46;5&#37; a few years ago&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> These data coincide with the preliminary results of an ongoing study by Caballeria et al&#46; investigating the use of hepatic elasticity measurements to diagnose asymptomatic liver diseases&#46; Of the 1026 asymptomatic participants who have undergone laboratory tests&#44; not one case of HCV infection has been found&#46; This apparent reduction in the prevalence of chronic HCV in our community is not surprising given the virtual disappearance of some of the major risk factors for HCV infection &#40;such as uncontrolled blood product transfusions and intravenous drug use&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; the strategies of mass mailings to the general population and static advertising in PCT offices encouraging people to undergo laboratory tests to detect occult HCV infections are not effective methods for the diagnosis of such infections in the general population&#46; Other strategies such as radio&#44; television or press advertisements should be studied in order to increase the diagnosis of occult HCV infection&#46; A more effective strategy for detecting occult HCV is performing serological examinations on patients with chronic hypertransaminasemia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate which of the three studied strategies is the most effective to detect new cases of hepatitis C virus &#40;HCV&#41; infections in primary care&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is an observational&#44; prospective&#44; and multicentre study evaluating three strategies&#46; Strategy 1&#58; provide an explanatory letter to adults assigned to two primary care teams &#40;PCTs&#41;&#44; inviting them to have a blood test&#46; Strategy 2&#58; place posters and leaflets in PCTs advertising the possibility of laboratory tests&#46; Strategy 3&#58; reexamine HCV antibody test results in patients with hypertransaminasemia diagnosed within the last two years through electronic records&#44; and determine anti-HCV status in undiagnosed cases&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were a total 598 participants &#40;51&#37; female with an average age of 50&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 years&#41;&#46; There were 238 people &#40;4&#46;1&#37; of letters sent&#41; in Strategy 1&#44; 69 people &#40;0&#46;3&#37; of potential participation&#41; in Strategy 2&#44; and 291 people &#40;100&#37; participation&#41; from Strategy 3&#46; One new case of HCV was found in both Strategy 1 and Strategy 2&#44; representing a prevalence of 0&#46;4 and 1&#46;4&#37;&#44; respectively&#46; Two new cases of HCV were found in Strategy 3&#44; representing a prevalence of 0&#46;7&#37;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The three studied strategies for detecting new cases of HCV infection are ineffective&#44; especially in regards to their cost and effort&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar cual de las 3 estrategias ensayadas es m&#225;s efectiva para detectar nuevos casos de infecci&#243;n por virus de la hepatitis C &#40;VHC&#41; en atenci&#243;n primaria&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; prospectivo y multic&#233;ntrico&#46; Se evaluaron 3 estrategias&#58; Estrategia 1&#58; carta explicativa dirigida a personas adultas adscritas a 2 equipos de atenci&#243;n primaria &#40;EAP&#41;&#44; invit&#225;ndoles a realizar un examen serol&#243;gico&#46; Estrategia 2&#58; colocaci&#243;n en los EAP de p&#243;steres y d&#237;pticos explicativos&#44; ofreciendo la posibilidad de realizar un examen anal&#237;tico&#46; Estrategia 3&#58; revisar el resultado de anti-VHC en los pacientes con hipertransaminasemia detectada en los &#250;ltimos 2 a&#241;os mediante la historia electr&#243;nica y efectuar determinaci&#243;n del anti-VHC en los casos en quienes no se hab&#237;a determinado&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Participaron 598 personas &#40;51&#37; mujeres con una media de edad de 50&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 a&#241;os&#41;&#46; Con la estrategia 1 se captaron 238 personas &#40;4&#44;1&#37; de participaci&#243;n&#41;&#44; con la estrategia 2&#44; 69 personas &#40;0&#44;3&#37;&#41; y con la estrategia 3&#44; 291 pacientes &#40;100&#37;&#41;&#46; La detecci&#243;n de VHC oculto fue de un caso en las estrategias 1 y 2&#44; representando una prevalencia del 0&#44;4 y 1&#44;4&#37;&#44; respectivamente&#44; y de 2 casos en la estrategia 3 lo que representa una prevalencia de 0&#44;7&#37;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La b&#250;squeda activa de casos ocultos de infecci&#243;n por VHC ha sido poco efectiva con los m&#233;todos ensayados&#44; atendiendo al coste y esfuerzo que comportan&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Caballer&#237;a L&#44; Pera G&#44; Bernad J&#44; Canut S&#44; Navarro E&#44; Bruguera M&#46; Estrategias para la detecci&#243;n de infecci&#243;n por virus de la hepatitis C en poblaci&#243;n general&#46; Rev Clin Esp&#46; 2014&#59;214&#58;242&#8211;246&#46;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">What we know&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Hepatitis C virus &#40;HCV&#41; infection is a healthcare problem of considerable magnitude&#46; Many people with HCV infection do not know that they are infected and therefore cannot benefit from available treatments and can even unknowingly transmit the disease&#46; This study evaluated several strategies to detect unknown cases of HCV in the adult population within primary care&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">What this article provides&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall">The strategies of mass mailings to the general population and static advertising in primary care offices are not effective&#46; A more effective strategy is to perform HCV serological examinations on patients with hypertransaminasemia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
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Journal Information
Vol. 214. Issue 5.
Pages 242-246 (June - July 2014)
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Vol. 214. Issue 5.
Pages 242-246 (June - July 2014)
Brief Original
Strategies for the detection of hepatitis C viral infection in the general population
Estrategias para la detección de infección por virus de la hepatitis C en población general
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L. Caballeríaa,b,
Corresponding author
lcaballeria.bnm.ics@gencat.cat

Corresponding author.
, G. Peraa,b, J. Bernadb,c, S. Canutb,c, E. Navarrod, M. Bruguerae
a Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària (IDIAP) Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
c Centre d’Atenció Primària Vilassar de Mar, Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Vilassar de Mar, Barcelona, Spain
d Centre d’Atenció Primària Cassà de la Selva, Institut d’Assistència Sanitària de Girona, Cassà de la Selva, Girona, Spain
e Unidad de Hepatología, Hospital Clínic, Barcelona, Spain
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Abstract
Objective

To evaluate which of the three studied strategies is the most effective to detect new cases of hepatitis C virus (HCV) infections in primary care.

Methods

This is an observational, prospective, and multicentre study evaluating three strategies. Strategy 1: provide an explanatory letter to adults assigned to two primary care teams (PCTs), inviting them to have a blood test. Strategy 2: place posters and leaflets in PCTs advertising the possibility of laboratory tests. Strategy 3: reexamine HCV antibody test results in patients with hypertransaminasemia diagnosed within the last two years through electronic records, and determine anti-HCV status in undiagnosed cases.

Results

There were a total 598 participants (51% female with an average age of 50.6±13 years). There were 238 people (4.1% of letters sent) in Strategy 1, 69 people (0.3% of potential participation) in Strategy 2, and 291 people (100% participation) from Strategy 3. One new case of HCV was found in both Strategy 1 and Strategy 2, representing a prevalence of 0.4 and 1.4%, respectively. Two new cases of HCV were found in Strategy 3, representing a prevalence of 0.7%.

Conclusions

The three studied strategies for detecting new cases of HCV infection are ineffective, especially in regards to their cost and effort.

Keywords:
Hepatitis C
Serology
Transaminases
Primary health care
Resumen
Objetivo

Evaluar cual de las 3 estrategias ensayadas es más efectiva para detectar nuevos casos de infección por virus de la hepatitis C (VHC) en atención primaria.

Métodos

Estudio observacional, prospectivo y multicéntrico. Se evaluaron 3 estrategias: Estrategia 1: carta explicativa dirigida a personas adultas adscritas a 2 equipos de atención primaria (EAP), invitándoles a realizar un examen serológico. Estrategia 2: colocación en los EAP de pósteres y dípticos explicativos, ofreciendo la posibilidad de realizar un examen analítico. Estrategia 3: revisar el resultado de anti-VHC en los pacientes con hipertransaminasemia detectada en los últimos 2 años mediante la historia electrónica y efectuar determinación del anti-VHC en los casos en quienes no se había determinado.

Resultados

Participaron 598 personas (51% mujeres con una media de edad de 50,6±13 años). Con la estrategia 1 se captaron 238 personas (4,1% de participación), con la estrategia 2, 69 personas (0,3%) y con la estrategia 3, 291 pacientes (100%). La detección de VHC oculto fue de un caso en las estrategias 1 y 2, representando una prevalencia del 0,4 y 1,4%, respectivamente, y de 2 casos en la estrategia 3 lo que representa una prevalencia de 0,7%.

Conclusiones

La búsqueda activa de casos ocultos de infección por VHC ha sido poco efectiva con los métodos ensayados, atendiendo al coste y esfuerzo que comportan.

Palabras clave:
Hepatitis C
Serología
Transaminasas
Atención Primaria de Salud

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