Current State of and Needs for Hepatitis B Screening: Results of a Large Screening Study in a Low-Prevalent, Metropolitan Region

<div><p>Background</p><p>In low hepatitis B virus (HBV)-prevalent countries, most HBV-infected persons are unaware of their status. We aimed to evaluate whether (i) previous HBV-testing, (ii) physicians decision to screen, and (iii) CDC's recommendations identified infected individuals and which risk-factor groups needing testing.</p><p>Methods</p><p>During a mass, multi-center HBV-screening study from September 2010-August 2011, 3929 participants were screened for hepatitis B surface antigen (HBsAg), anti-HBs and anti-Hepatitis B core antibodies (anti-HBcAb). Questions on HBV risk-factors and testing practices were asked to participants, while participants' eligibility for HBV-testing was asked to study medical professionals.</p><p>Results</p><p>85 (2.2%) participants were HBsAg-positive, while 659 (16.8%) had either resolved HBV infection or isolated anti-HBcAb. When comparing practices, HBV-testing was more likely to occur in HBV-infected participants if Centers for Disease Control and Prevention (CDC) recommendations were used (Sensitivity = 100%, 95%CI: 95.8–100) than physicians' discretion (Sensitivity = 87.1%, 95%CI: 78.0–93.4) or previous HBV-test (Sensitivity = 36.5%, 95%CI: 26.3–47.6) (p<0.0001). Nevertheless, many non-infected individuals would still have been screened using CDC-recommendations (Specificity = 31.1%, 95%CI: 29.6–32.6). Using multivariable logistic regression, HBsAg-positive status was significantly associated with the following: males, originating from high HBV-endemic region, contact with HBV-infected individual, without national healthcare, and intravenous-drug user (IDU). Of these risk-factors, physician's discretion for testing HBV was not significantly associated with participants' geographical origin or IDU.</p><p>Conclusions</p><p>Missed opportunities of HBV-screening are largely due to underestimating country of origin as a risk-factor. Applying CDC-recommendations could improve HBV-screening, but with the disadvantage of many tests. Further development of HBV-testing strategies is necessary, especially before severe disease occurs.</p></div

Definition of HBV infection status.

<p>Definition of HBV infection status.</p

Determinants of testing practices and HBsAg-positive status.

<p>For each endpoint, all variables in the risk-factor column were used in the multivariable logistic regression model except for those with “—”. Further details on model construction are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092266#pone.0092266.s001" target="_blank">Table S1</a>.</p><p>*Thirteen patients were excluded from analysis as they had missing data on parent's geographical origin.</p><p>**Fifteen patients were excluded from analysis as 13 had missing data on parent's geographical origin, one had missing age, and one had missing physician's recommendation for testing.</p>1<p>Endpoint defined as if the study physician would have tested the participant for HBV per study center's protocol.</p>2<p>Includes participants with government assistance (CMU, AME) and “other” health insurance plans.</p

HBV-infection status within groups of risk-factors for HBV transmission.

<p>HBV, hepatitis B virus; Int., intermediate; MSM, men who have sex with men; IDU, intravenous drug use.</p

Comparison of testing practices with respect to HBV-infection status.

<p>*Comparing HBV-status in column with non-immunized/vaccinated individuals.</p>1<p>If the study physician would have tested the participant for HBV per study center's protocol.</p>2<p>If a participant would have been tested using the Center for Disease Control and Prevention (CDC) criteria for HBV screening.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092266#pone.0092266-Weinbaum1" target="_blank">[7]</a>.</p

Study Flow Diagram.

<p>Study Flow Diagram.</p

Performance of testing practices for HBsAg-positive individuals.

1<p>If the study physician would have tested the participant for HBV per study center's protocol. One non-exposed participant had missing information and was excluded from this analysis.</p>2<p>If a participant would have been tested using the Center for Disease Control and Prevention (CDC) criteria for HBV screening <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092266#pone.0092266-Weinbaum1" target="_blank">[7]</a>.</p