Prevalence of HCV infection in vulnerable populations: DETECT-C program a real contribution to hepatitis C elimination in these groups in Spain
To meet the objectives set by the WHO for the elimination of hepatitis C in 2030, it is necessary to address vulnerable groups. Our aim was help facilitating the screening of Hepatitis C Virus (HCV) at the Point of Care (PoC) of vulnerable populations, and the referral of HCV positive patients. In November 2019, SOCIDROGALCOHOL Scientific Society launched the 'DETECT-C' program for the diagnosis of HCV at PoC, including the rapid test in oral fluid (Oraquick) and in dry blood spot devices (DBS), aiming to screening HCV in vulnerable population attended at addiction centers and other settings, such as shelters, mental health, immigrant or social insertion centers, among others. Moreover, in 2020, a pilot GeneXpert for RNA screening at a harm reduction center was implemented within this program. In early 2022, a Centralized Laboratory of Reference to analyse viremia in DBS devices was also included.
Of the 38 centers that submitted reports, 1,589 Oraquick tests were performed, of which 164 were positive, indicating a prevalence of HCV antibodies of 10.4%. Which is 12 times higher than the prevalence reported in the general population (0.85%) at the 2nd Seroprevalence Survey in Spain. 93% of patients anti-HCV positive test were referred to primary or specialized care. In the case of dried blood devices, RNA prevalence was 42% (21/50), all HCV-positive individuals were referred to specialized care. GeneXpert and Reference laboratory data will be analyzed and presented. The prevalence found in vulnerable groups is higher than in the general population, therefore, it is important to continue promoting and facilitating PoC HCV testing and linkage to care for all positive patients. It was evident the need to have a reference laboratory for viremia diagnosis in DBS cards together with a reference hospital specialist to ensure direct referral of patient for disease management.