Linkage to care of HbsAg-positive and anti-HCV-positive patients after a systematic screening approach in the German primary care setting

BACKGROUND: Identification of previously unknown cases is important to lower the burden of chronic hepatitis B and C infection. However, a screening program in the primary care setting has not yet been established. Therefore, a systematic screening project was conducted in 21 008 patients (Wolffram and colleagues). Here, we describe linkage to care of identified HbsAg-positive and anti-hepatitis C virus (HCV)-positive patients. METHODS: General practitioners characterized further medical care by a standardized questionnaire. Data of 48/110 HbsAg-positive and 114/199 anti-HCV-positive patients were available. An APRI index more than 2 or up to 0.5 indicated the presence of cirrhosis or the absence of fibrosis. RESULTS: APRI was calculated in 32/48 hepatitis B virus (HBV) patients (>2: n=1; ≤0.5: n=29) and 34/114 HCV patients (>2: n=4; ≤0.5: n=23). The general practitioners were already aware of the positive HBsAg and anti-HCV-test in 13/48 and 59/114 patients, respectively.For 29/35 newly diagnosed HBV patients and 26/55 HCV patients, further diagnostics were initiated: ultrasound 77 versus 38%, liver biopsy 20 versus 4%, and gastroscopy 20 versus 7%.Antiviral treatment was initiated in 5/35 HBV cases and in 10/55 HCV patients.A family screening was initiated in 22/35 HBV versus 13/55 HCV index patients and showed one additional HbsAg-positive and two anti-HCV-positive cases.Diagnostic procedures differed significantly between anti-HCV-positive and HbsAg-positive patients (P<0.001 for APRI, ultrasound, and family screening; P=0.03 for liver biopsy). CONCLUSION: Diagnostic procedures should be improved for hepatitis C-infected patients. The APRI index was only of limited value in the primary care setting.