title: Current state of and needs for hepatitis B screening: results of a large screening study in a low-prevalent, metropolitan region.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Bottero
authors.affiliation: Inserm UMR-S707, Paris, France.
authors.forename: Anders
authors.initials: A
authors.lastname: Boyd
authors.affiliation: Service d'Hépatologie, Hôpital St Antoine, AP-HP, Paris, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Lemoine
authors.affiliation: Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Unité de Santé Publique, Hôpital St Antoine, AP-HP, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Carrat
authors.affiliation: Laboratoire de Virologie, Hôpital St Antoine, AP-HP, Paris, France.
authors.forename: Joel
authors.initials: J
authors.lastname: Gozlan
authors.affiliation: Laboratoire St Marcel, Mairie de Paris, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Collignon
authors.affiliation: Direction de l'Action Sociale, de l'Enfance et de la Santé, Mairie de Paris, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boo
authors.affiliation: Centre de dépistage anonyme et gratuit (CDAG) du Figuier, Mairie de Paris, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dhotte
authors.affiliation: Département des Examens Périodiques de Santé (DEPS), CPAM de Paris, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Varsat
authors.affiliation: CDAG de Belleville, Paris, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Muller
authors.affiliation: Policlinique Baudelaire, Hôpital St Antoine, AP-HP, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cha
authors.affiliation: Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Valin
authors.affiliation: Centre d'accueil, de soins et d'orientation, Médecins du Monde, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Nau
authors.affiliation: Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Campa
authors.affiliation: Unité de consultation et de soins ambulatoires (UCSA), Maison d'arrêt de la santé, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Silbermann
authors.affiliation: Centre Croix Rouge du Moulin Joly, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bary
authors.affiliation: Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.affiliation: Inserm UMR-S707, Paris, France; Université Pierre et Marie Curie, Paris, France; Service de Maladies Infectieuses, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Lacombe
mesh_terms: D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S.; D002947:Cities / Q000453:epidemiology*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010820:Physicians; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D006514:Hepatitis B Surface Antigens