A randomized trial of viral hepatitis prevention among underprivileged people in the Lyon area of France.
BACKGROUND
We compared the efficacy of two viral hepatitis B and C (VHBC) screening strategies, relative to no intervention, among underprivileged people (UP) living in shelters in the Lyon area.


METHODS
Eighteen of 37 shelters were randomly sampled after stratification based on the accommodation capacity and the screening centres/shelters distance. Through randomization, the S0 strategy (no intervention), the S1 strategy [group information (GI) and referral for screening] and the S2 strategy (GI and in situ screening) were each applied in six shelters. A standardized questionnaire was offered to each participant. Follow-up of positive cases was organized via the reference centre of VHBC of Lyon.


RESULTS
The screening completion rate (SCR) among 1276 included subjects in S0, S1 and S2 was 1.5, 42.8 and 59.7%, respectively (P < 10(-6)). This rate was higher in S2 regardless of the sociodemographic variable considered. Odds ratios (OR) of screening completion (SC) was significantly higher in S1 versus S0, OR = 49.8 [95% confidence interval (CI): 26.1-102.1], in S2 versus S0, OR = 98.5 (95% CI: 51.9-200.8) and in S2 versus S1, OR = 2.0 (95% CI: 1.3-2.9). Age, country of birth and professional inactivity were independently associated with SC.


CONCLUSIONS
Health authorities must ensure widespread screening of UP, which is more effective when conducted in shelters than in screening centres.
Sahajian
F
F
ADHEC Program, Laboratory of Epidemiology and Public Health, University of Lyon, Domaine Rockefeller, 8, Avenue Rockefeller, 69373 Lyon Cedex 08, France. frederic.sahajian@ch-le-vinatier.fr
Bailly
F
F
Vanhems
P
P
Fantino
B
B
Vannier-Nitenberg
C
C
Fabry
J
J
Trepo
C
C
D000293:Adolescent; D000328:Adult; D002353:Carrier State / Q000097:blood; D005260:Female; D005602:France / Q000453:epidemiology; D006509:Hepatitis B / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006526:Hepatitis C / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D006525:Hepatitis, Viral, Human; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011203:Poverty; D012307:Risk Factors; D012946:Social Welfare; D011795:Surveys and Questionnaires; D055815:Young Adult
D006510:Hepatitis B Antibodies