title: Targeted hepatitis C screening among ex-injection drug users in the community.
abstract: OBJECTIVE
  Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. It is highly prevalent among injection drug users (IDUs) but is often undiagnosed because they represent an underprivileged group that faces multiple barriers to medical care. Here, we report the results of the New Life New Liver Project, which provides targeted HCV screening and education for ex-IDUs in the community.
  
  
  METHODS
  Patients were recruited through the social worker networks and referrals by fellow ex-IDUs, and rapid diagnosis was based on point-of-care anti-HCV testing at rehabilitation centers.
  
  
  RESULTS
  From 2009 to 2012, we served 234 subjects. One hundred thirty (56%) subjects were anti-HCV positive. The number needed to screen to detect one patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6-2.0). However, only 69 (53%) HCV patients attended subsequent follow-up at regional hospitals, and 26 (20%) received antiviral therapy. Patients who attended follow-up were older, had higher education level and more active disease as evidenced by higher alanine aminotransferase, HCV RNA, and liver stiffness measurement by transient elastography.
  
  
  CONCLUSIONS
  Targeted screening in ex-IDUs is effective in identifying patients with HCV infection in the community. Improvement in the referral system and introduction of interferon-free regimens are needed to increase treatment uptake.
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.forename: Angel Mei-Ling
authors.initials: AM
authors.lastname: Chim
authors.forename: Tsz-Fai
authors.initials: TF
authors.lastname: Cheng
authors.forename: Shirley Wing-Yan
authors.initials: SW
authors.lastname: Cheung
authors.forename: Carol Man-Sze
authors.initials: CM
authors.lastname: Lai
authors.forename: Kylie Joan-Yi
authors.initials: KJ
authors.lastname: Szeto
authors.forename: Sharon
authors.initials: S
authors.lastname: Tsang
authors.forename: Stephen Ho-Chun
authors.initials: SH
authors.lastname: Wu
authors.forename: Kenneth Kar-Lung
authors.initials: KK
authors.lastname: Yan
authors.forename: Alex Yui
authors.initials: AY
authors.lastname: Hui
authors.forename: Desmond Chi-Him
authors.initials: DC
authors.lastname: Yiu
authors.forename: Brian Bing-Ying
authors.initials: BB
authors.lastname: Wu
authors.forename: David
authors.initials: D
authors.lastname: Cheung
authors.forename: Cedric Sze-Lai
authors.initials: CS
authors.lastname: Chung
authors.forename: Camey Wai-Man
authors.initials: CW
authors.lastname: Lai
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000410:Alanine Transaminase; D015415:Biomarkers; D003153:Community Health Services; D019058:Community Networks; D055030:Drug Users / Q000706:statistics & numerical data*; D054459:Elasticity Imaging Techniques; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010353:Patient Education as Topic; D019095:Point-of-Care Systems; D012367:RNA, Viral; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012367:RNA, Viral; D000410:Alanine Transaminase
keywords: elasticity; interferons; liver cirrhosis; opioid-related disorders; patient compliance