Survey finds gaps in HBV, HCV testing guides, outcome data

The European Center for Disease Prevention and Control recently published results of two semi-structured surveys that found a wide variation in existing national testing policy and lack of monitored data for hepatitis B and hepatitis C in the EU/EEA member states.

“The purpose of this work was to provide a baseline situation assessment to inform the guidance development process and to assess the availability and feasibility of collecting additional morbidity and mortality data from EU/EEA Member States,” the researchers wrote. “As a subsidiary objective, the availability of information to monitor the HBV and HCV epidemic was assessed against the core indicators defined in the WHO Regional Action Plan for viral hepatitis.”

The first survey was designed to assess the current available guides for HBV and HCV testing and conclude the current needs and priority areas related to hepatitis testing in member states. The objective of the second survey was to obtain data on the burden of HBV and HCV morbidity and mortality for use by the ECDC.

Of 31 member states, 21 responded to Survey 1 and 22 responded to Survey 2. The states that responded included Belgium, Bulgaria, Croatia, Denmark, Estonia, France, Germany, Hungary, Ireland, Italy, Latvia, Lithuania, Malta, Netherlands, Norway, Poland, Romania, Slovenia (Survey 2 only), Spain, Sweden and the U.K.

Survey 1

Nineteen countries responded that they had national-level testing guidance for HBV and six countries had dedicated guidance. Eighteen countries had national-level testing guidance for HCV and 10 had dedicated guidance. Nine countries reported that HBV or HCV testing guidance was included in other documents such as blood donation policy, one reported using the EASL guideline and four countries reported using guidelines from EASL, WHO, CDC or the European Monitoring Center for Drugs and Drug Addiction. Five countries reported they were in the process of developing or updating national hepatitis guidelines.

Thirteen countries had policies for testing people who inject drugs; however, there were common risk groups frequently omitted, including commercial sex workers, men who have sex with men, those practicing unsafe use of tattoos or piercings, and homeless individuals. Eighteen countries had policies for testing pregnant women for HBV compared with six countries with policies for HCV. Only five countries reported policies on the frequency of HBV testing. Seventeen countries provided information on testing practice for HBV and HCV in prison settings, though the options varied.

Nine countries provided information on use of point of care or dried blood spot testing, though the responses varied with six countries using point of care tests, four using dried blood spot testing and one that used neither.

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Fifteen countries reported using more than one type of approach to fund HBV and HCV testing, nine countries reported access to HBV and HCV testing with reimbursed user-fees in at least certain settings, and three reported use of non-reimbursed user fees.

While 19 and 16 countries conducted monitoring of at least one testing, diagnosis or treatment indicator of HBV or HCV, respectively, no countries monitored either the number of HBV or HCV tests offered or the number of people offered a test.

Nine and eight countries believed there were existing gaps in testing policies in their country for HBV and HCV, respectively. Seventeen countries felt that risk groups, particularly people who inject drugs, were not being targeted effectively for HBV and 16 countries felt the same for HCV.

Survey 2

Responses to Survey 2 quantified the number of countries with available morbidity data for liver cirrhosis (n = 18), chronic liver disease (n = 14), liver cancer (n = 20), end stage liver disease (n = 12) and liver transplant (n = 18). Fewer countries also recorded the HBV or HCV status of individuals with morbidity data for liver cirrhosis (n = 6), chronic liver disease (n = 7), liver cancer (n = 6), end stage liver disease (n = 6) and liver transplant (n = 7).

The survey also recorded the available mortality data for liver cirrhosis (n = 18), chronic liver disease (n = 16), liver cancer (n = 21), and end stage liver disease (n = 12). Compared with overall mortality rate records, fewer countries recorded HBV or HCV status in cases of liver cirrhosis (n = 5), chronic liver disease (n = 5), liver cancer (n = 6) and end stage liver disease (n = 4).

“The survey findings reveal a wide variation in testing policy and practice across the EU/EEA, and a number of significant gaps,” the researchers concluded. “Just over half of responding countries agreed that there is a need for European-level testing guidance, in particular guidance covering who to test, how to target those at risk, and monitoring and evaluation of testing initiatives. Many respondents cited the need for practical/toolkit-type guidance that would be readily available, eg, on the ECDC website. It was considered that this guidance could support the development of national guidance documents, add value to existing guidance, and would be timely, given the increasing movement of populations across national borders.” – by Talitha Bennett

References: European Center for Disease Prevention and Control. “Hepatitis B and C testing activities, needs, and priorities in the EU/EEA.” Stockholm: ECDC; May 2017. www.ecdc.europa.eu.