The impact of the prevention programme of hepatitis C over more than a decade: the French experience.
To assess the impact of the French national hepatitis C prevention programme initiated in 1999, we analysed trends in hepatitis C virus (HCV) prevalence, testing and characteristics of HCV-infected patient at first referral from 1994 to 2006. We used four data sources: Two national population-based sero-prevalence surveys carried out in 1994 and 2004; two surveillance networks, one based on public and private laboratories throughout France and the other on hepatology reference centres, which aim to monitor, respectively, trends of anti-HCV screening and of epidemiological-clinical characteristics of HCV patients at first referral. Between 1994 and 2004, the anti-HCV prevalence for adults aged 20-59 years decreased from 1.05 (95% confidence interval 0.75-1.34) to 0.71 (0.52-0.97). During the same period, those anti-HCV positive with detectable HCV RNA decreased from 81 to 57%, whereas, the proportion of anti-HCV positive persons aware of their status evolved from 24 to 56%. Anti-HCV screening activity increased by 45% from 2000 to 2005, but decreased in 2006 (-10%), while HCV positivity among those tested decreased from 4.3 to 2.9%. The proportion of cirrhosis at first referral remains around 10% between 2001 and 2006, with many patients with excessive alcohol consumption (34.7% among males) or viral co-infections (HIV seropositivity for 5.2% patients). Our analysis indicates that the national programme had a positive impact at the population level through improved prevention, screening and management. There is still a need to identify timely those at risk for earlier interventions, to assess co-morbidities better and for a multidisciplinary approach to HCV management.
Institut de veille sanitaire, Saint-Maurice, France. edelaroc@pasteur.fr
E
E
Delarocque-Astagneau
C
C
Meffre
F
F
Dubois
C
C
Pioche
Y
Y
Le Strat
F
F
Roudot-Thoraval
P
P
Hillon
C
C
Silvain
D
D
Dhumeaux
J-C
JC
Desenclos
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods*; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D016036:Seroepidemiologic Studies; D055815:Young Adult
D018937:Hepatitis C Antibodies; D012367:RNA, Viral