Screen for hepatitis C while vaccinating for COVID-19, say Spanish experts

Olena Yakobchuk/

Governments should take the opportunity to screen their populations for hepatitis C as they roll out national vaccination programmes, a coalition of Spanish scientific societies and patient associations has recommended.

They say that using the waiting time before or after vaccination to take blood samples for dried blood spot testing would enable large-scale screening. They point to the example of SARS-CoV-2 screening carried out in northern Italy in 2020. Rapid hepatitis C testing was integrated into the screening programme; almost 3% of those screened had hepatitis C antibodies.

Hepatitis C testing in gay and bisexual men with HIV below target, US study finds

LightField Studios/ Image for illustrative purposes only.

Testing for hepatitis C among gay and bisexual men with HIV who are at higher risk of acquiring hepatitis C is falling short of recommendations, a study of a large US cohort of people in regular HIV care shows.

Gay and bisexual men with HIV have a high prevalence of hepatitis C and studies in Europe and North America have shown high incidence of hepatitis C among this group over the past two decades, largely due to sexual transmission.

The US HIV Outpatients Study looked at all tests for hepatitis C in gay and bisexual men in their cohort between 2011 and 2019. They found that the men at greatest risk of hepatitis C acquisition were no more likely to be tested than people at low risk or the sexually inactive, and that only 30% of gay and bisexual men receiving care received a test in any year between 2011 and 2019. The US Centers for Disease Control and Prevention recommends that anyone with HIV reporting risk factors for hepatitis C exposure, including condomless sex between men, should be tested annually.

Improved awareness of the guidelines on testing among healthcare providers, information on testing and hepatitis C risk factors for people with HIV, and screening for potential risk behaviours at each HIV clinic visit in order to identify people at higher risk would help to improve testing rates, the researchers say.

Swiss opioid substitution therapy programme reports strong progress towards hepatitis C elimination

Josh Estey/DFAT. Creative Commons licence.

Direct-acting antiviral treatment cured almost everyone treated for hepatitis C in a large cohort of people receiving opioid substitution therapy, Swiss researchers report in the Swiss Medical Weekly.

The study also observed a substantial fall in new hepatitis C diagnoses among people receiving opioid substitution therapy (OST) during a two-year period after direct-acting antiviral (DAA) treatment was made available to everyone with hepatitis C in Switzerland regardless of liver disease stage.

A high level of engagement in OST, mainly prescribed by general practitioners, allows regular screening for hepatitis C and referral for hepatitis C treatment. However, some countries have proved reluctant to provide DAA treatment to people on OST, citing concerns about adherence to DAA treatment and hepatitis C reinfection among people who continue to inject drugs while receiving OST.

The Swiss Association for the Medical Management of Substance Users (SAMMSU) cohort has recruited participants through OST programmes in eight towns and cities since 2014. Analyses of chronic hepatitis C prevalence, treatment uptake and cure rates between 2017 and 2019 showed that by 2019, 79% of people who had tested positive for hepatitis C had undergone hepatitis C treatment. Of those treated, 95% had either been cured or had a negative hepatitis C virus (HCV) viral load by 1 May 2019. The prevalence of HCV viraemia in the cohort decreased from 36% in 2017 to 19% in 2019 among people who had tested positive for HCV antibodies.

Adherence to DAA treatment was very good; 98% of participants had excellent adherence. In the period between 2017 and 2019, 35 reinfections were observed, a rate of 1.6 cases per 100 person-years of follow-up. New cases of hepatitis C in people previously negative for hepatitis antibodies have fallen from approximately 30 new diagnoses in 2013 to less than ten in 2019.

The researchers conclude that very high rates of treatment uptake are possible in OST recipients with hepatitis C and that adherence and treatment success are excellent. “Treating chronic hepatitis C in [OST] patients requires an extra effort,” they conclude, highlighting several practices which support treatment uptake:

  • Switzerland introduced DAA prescribing by general practitioners in 2019, allowing OST providers to offer hepatitis C treatment on site, rather than referring patients to liver specialists.
  • Dried blood spot sampling for HCV viral load testing and use of APRI scores instead of Fibroscan to identify patients at highest risk of fibrosis allow decentralised settings such as general practitioners or pharmacies to diagnose chronic hepatitis C and assess patients for treatment without the need for hospital referral.
  • Directly observed treatment alongside OST supports adherence; 45% of people received their treatment as a directly observed regimen.

Community-wide hepatitis C elimination campaign in Seattle increases number treated tenfold


A community-wide hepatitis C elimination campaign in Seattle, United States, tripled the number of people screened for hepatitis C and increased the number treated tenfold between 2014 and 2018, doctors and public health specialists report in the March edition of Hepatology Communications.

The campaign had five key elements:

  • Screening: Focusing on baby boomers, clinics introduced electronic medical record flags to prompt hepatitis C antibody testing in everyone born between 1945 and 1965 or mailed screening reminders to eligible patients. Posters in clinics advertised screening and encouraged patients to speak with their healthcare provider about it.
  • Training for healthcare providers: an extensive training programme used telemedicine, online tutorials and in-service trainings to train 252 primary care providers in hepatitis C evaluation and treatment.
  • Case management: To ensure linkage to care, public health departments and the Hepatitis Education project provided support to ensure that people diagnosed with hepatitis C could navigate from testing to cure by providing information on medical services and financial aspects of obtaining treatment.
  • Public awareness campaign: Public health departments used a range of media to raise awareness of hepatitis C in Seattle. Targeted outreach to Black and ethnic minority communities and through needle and syringe programmes targeted groups with potentially high prevalence of hepatitis C.
  • Data monitoring: public health departments developed a data monitoring system to track progress through the hepatitis C care cascade and used data to adjust services.

Between 2013 and 2014, when direct-acting antiviral treatment was introduced, and 2017 and 2018, 77,577 baby boomer patients were screened for hepatitis C. The proportion of people in the baby boomer birth cohort screened for hepatitis C rose from 18% of people who visited a participating clinic in 2013-14 to 54% in 2017-18. The increase in screening was strongly linked to the introduction of electronic medical record prompts.

Comparison of the care cascades in Year 1 and Year 4 show that of 4694 people diagnosed with chronic infection, just under 6% started hepatitis C treatment and less than 4% were cured in Year 1. By Year 4, 52% of people diagnosed with chronic hepatitis C infection (8270) started treatment and 39% had been confirmed as cured by the end of the period. Overall, the number treated increased by 1263%.

The Seattle project achieved a much greater increase in baby boomer testing than the US average over the same period, which rose from 12.3% to 17.3%. The researchers say the success of the project was attributable to the multiple interventions, the range of partners collaborating on hepatitis C elimination and the lifting of fibrosis-related restrictions on hepatitis C treatment in Washington state in 2016.

Reinfection after hepatitis C cure predicted by sexually transmitted infections

Domizia Salusest |

Screening for sexually transmitted infections in people co-infected with HIV and hepatitis C during or shortly after completing direct-acting antiviral treatment to cure hepatitis C may predict which patients are at higher risk of hepatitis C reinfection, a study carried out in San Diego reports.

The study found that people who became reinfected after being cured were significantly more likely to test positive on a gonorrhoea-chlamydia screen during treatment or in the 12 weeks after completing treatment.

Reinfection with hepatitis C after being cured of the virus by direct-acting antiviral treatment is more common in gay and bisexual men with HIV than in people who inject drugs. Studies in Europe and North America have reported high rates of reinfection.

To investigate the rate of reinfection among people with HIV in San Diego, researchers at the University of California San Diego carried out a prospective study among all people with HIV cured of hepatitis C between 2014 and 2019.

During treatment, participants were screened for STIs and underwent urine drug screens at each clinical visit. Screening also took place 12 weeks after completion of treatment.

During a median follow-up period of 1.38 years, eight out of 200 people were reinfected with hepatitis C (2.44 cases per 100 person-years of follow-up). Twenty-five per cent of people with a positive gonorrhoea-chlamydia result prior to achieving a sustained virologic response were reinfected, compared to 3% of those without a positive screen.

The study investigators say that STI testing may help to identify those at risk of reinfection, but they acknowledge that counselling appears to have limited effectiveness in influencing behaviours that increase the risk of hepatitis C reinfection. However, positive STI screening results might be used as a prompt for intensified counselling before the completion of treatment, potentially improving the effectiveness of counselling.

HepB Global Community: a global online forum supporting people affected by hepatitis B

The World Hepatitis Alliance is pleased to support the official launch of, a global online forum dedicated to supporting those living with and affected by hepatitis B.

Founder of the new online forum and Westmead Hospital’s hepatitis B researcher, Dr Thomas Tu said,Hepatitis B affects almost 300 million people globally and kills 800,000 people per year through liver cancer or liver failure.”

“While hepatitis B remains incurable, it can be managed and treated. But, people with hepatitis B face social stigma and discrimination, discouraging them from seeking medical help that could prevent progression of their illness to serious disease like liver cancer,” said Dr Tu.

Living with hepatitis B himself, Tu founded for affected people worldwide to connect with each other, form support networks, and get advice from verified medical experts and researchers.

“The site is peer-led, volunteer-run, and free to join. We already have over 200 members from all over the world,” said Dr Tu.

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