Present status of community-based HCV screening in Osaka City and evaluation of the utility of follow-up programs on hepatitis

Objective The present status of community-based HCV screening in Osaka City and the utility of follow-up programs on hepatitis were examined.<br/>Method During a period of three years, from 2003-2005, 83, 458 persons who underwent HCV testing in a community-based HCV screening program in Osaka City were targeted. These persons were 40 years of age or older who opted to receive testing for HCV antibodies. To assist patients testing positive for HCV, hepatitis follow up programs were carried out. For cases where consent was given, the performance or nonperformance of a thorough examination could be ascertained with regard to whether or not a thorough examination results notification was sent from the medical institution. For patients who did not receive a notification, a health nurse checked whether a thorough examination was received, by telephone or visit, usually two times (after 3 months and after 6 months) on average. If an examination had not been received, the nurse suggested having one. Furthermore, the contents of the thorough examination and other details like procedure plans for all patients were obtained through the thorough examination results notification. From continuous diagnostic reports from the medical institutions, an assessment was given and the information was provided to each medical institution.<br/> For cases where consent was not given for the follow up programs, only the results of the thorough examination were available.<br/>Results The percentage of patients testing positive for HCV antibodies showed a yearly decline, with 3.9% in 2003, 3.8% in 2004, and 3.0% in 2005.<br/> The percentages of patients consenting to hepatitis follow up programs were 52.2% in 2003, 56.2% in 2004, and 59.1% in 2005. When comparing the percentage of patients receiving a thorough examination between those consenting to these programs and those not consenting, the consenting group was 82.6% and the non-consenting group was 37.5% in 2003, 77.1% and 37.7% in 2004, 78.0% and 34.3% in 2005, respectively. Consequently, the percentage of patients consenting to the examination significantly increased each year (P<0.001).<br/> From the diagnostic information which was sent, medical data could be provided for a total of 153 cases in 2003, 105 in 2004 and 58 in 2005. Furthermore, from among the contents, non-performance of imaging examination was most common with 107 cases (33.9%), followed by non-identification of the HCV subtype, non-performance of a fixed quantity examination, and non-performance of an HCV-RNA qualitative examination to verify the presence of final stage virus. There were 50 cases where the follow-up was discontinued due to normal liver functions even though the subjects tested positive for HCV (15.8%). There were 15 cases where the follow-up was discontinued even though an HCV-RNA qualitative examination had not been performed (4.7%). Information that a follow-up was necessary was provided in those cases.<br/>Conclusion In order for patients testing positive for HCV to receive an appropriate thorough examination and follow-up, assistance by verifying that the examination had been received and suggesting its necessity where this was not the case is useful. A more extensive performance of information provision to medical institutions is to be recommended.