Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.743
Peer-review started: May 5, 2018
First decision: June 5, 2018
Revised: June 27, 2018
Accepted: July 9, 2018
Article in press: July 10, 2018
Published online: October 27, 2018
Hepatitis C virus (HCV) infection, the leading cause of liver cancer and liver failure, is now curable with the recent emergence of short-duration, non-toxic, all-oral therapies. This breakthrough in curative therapies for HCV infection has renewed interest in developing mechanisms to improve the HCV care continuum (testing, linkage to care, treatment initiation, cure). This renewed interest in HCV has led to many countries updating their HCV testing recommendations.
The United States HCV Guidance Panel provides healthcare professionals with a single web-based resource for evidence-based, expert-developed recommendations for hepatitis C testing and management. HCV recommendations in countries around the world have been recently updated due to advances in HCV treatment. However, this data is not compiled in a central location. This report investigates HCV testing recommendations from the United States and other high-income countries. In preparation for making updates to the HCV Panel guidance, HCV testing recommendations from the top quartile of United Nations Human Development Index (HDI) countries were evaluated for similarities and differences.
The main objective of this study was to identify HCV testing recommendations from the top quartile of United Nations HDI countries. The identified HCV recommendations were evaluated for similarities and differences. These data have been used periodically by the HCV Guidance Panel to explore HCV testing recommendations globally for comparison to the United States for consideration in updating the HCV Panel guidance when additional peer-review data is available to support inclusion of the category in the United States.
A comprehensive search for current HCV testing recommendations from the top quartile of HDI countries was performed using a Google search with a combination of free text terms. Relevant terms included: country name, hepatitis C, HCV, screening, testing, recommendations, and guidelines. The Google results were then reviewed with experts in the field of hepatitis C (including email and in-person interviews) inquiring about any additional countries known to have HCV testing recommendations. Testing recommendations were considered if they were from a government body or represented collaborative recommendations between a government and a medical organization. To be included in our analysis, recommendations needed to be available online May 1, 2014-October 2, 2017. From May 1-October 30, 2014, two reviewers performed the initial searches and engaged consultants to identify HCV testing recommendations from very high HDI countries. Two reviewers re-reviewed HCV testing recommendations through Google searches and follow up with expert consults from April 1-October 2, 2017 to identify and update any changes.
Of the 51 countries identified, 16 had HCV testing recommendations from a government body or recommendations issued collaboratively between a government and a medical organization. Of these 16 countries, 15 had HCV testing recommendations that were primarily risk-based and highlight behaviors, exposures, and conditions that are associated with HCV transmission in that region. In addition to risk-based testing, the HCV Guidance Panel (United States) incorporates recommendations for a one-time test for individuals born during 1945-1965 (the birth cohort) without prior ascertainment of risk into their guidance. In addition to the United States, six other countries either have an age-based testing recommendation or recommend one-time testing for all adults independent of risk factors typical of the region.
This review affirmed the similarities of the HCV Guidance Panel’s guidance with those of recommendations from very high HDI countries. As a result of this initial work in 2014, solid organ donors (deceased and living) were identified as a group not included in the guidance and were thus considered for review. After additional review of the available literature on the subject, donors were added to the HCV Panel guidance in 2014 and given an evidence of rating of Class I, Level B. Prior to this, donors had not been explicitly named as a testing category but were discussed in the text below the testing guidance.
HCV testing recommendations from very high HDI countries will be continually reviewed and as new risk categories or universal screening recommendations are identified, they will be considered for incorporation into the HCV Panel guidance when peer-reviewed evidence is available to support the incorporation of the HCV testing practices in the United States.