Evaluation of the French national plan to promote screening and early management of viral hepatitis C, between 1997 and 2003: a comparative cross-sectional study in Poitou-Charentes region.
OBJECTIVE
The aim of this repeated cross-sectional survey was to document trends in screening practices, to analyze the evolution of the epidemiological characteristics of patients with newly diagnosed hepatitis C virus (HCV) infection, and to evaluate the implementation of hepatitis C management guidelines.


METHODS
Medical laboratories in Poitou-Charentes region were surveyed on serological tests for HCV infection prescribed during two 2-month periods in 1997 and 2000, and a 4-month period in 2003. An epidemiological questionnaire and a 12-month follow-up questionnaire were addressed to physicians who prescribed tests that were positive.


RESULTS
The annual screening coverage rate increased by 40% during the study period, whereas the number of positive tests fell by 53%. The estimated detection rate of new cases decreased from 43 to 26 per 100 000 inhabitants between 1997 and 2003. In 2003, 56% of serological tests were prescribed to patients who already knew that they were HCV-seropositive. The frequencies of the two main risk factors (transfusion and intravenous drug use) slightly decreased. Management of newly diagnosed patients was inappropriate in 42% of cases in 1997, 33% in 2000, and 34% in 2003; 26% of the participants at the three periods declined follow-up. Among drug users, the proportion of treated patients remained stable (17%). One-third of the drug users were lost to follow-up by their family doctor.


CONCLUSIONS
Campaigns to encourage HCV screening have been effective, but the number of newly diagnosed cases has fallen markedly. National campaigns targeting the general public and healthcare professionals seem to have had no impact on patient management: in particular, drug users still do not receive adequate follow-up.
Defossez
Gautier
G
Faculty of Medicine, University Institute of Public Health bThe Poitou-Charentes Hepatitis C Network, University Hospital La Milétrie, Poitiers, France. gautier.defossez@univ-poitiers.fr
Verneau
Alain
A
Ingrand
Isabelle
I
Silvain
Christine
C
Ingrand
Pierre
P
Beauchant
Michel
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006293:Health Promotion / Q000458:organization & administration; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D009313:National Health Programs; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology; D065227:Transfusion Reaction