Reducing the undiagnosed fractions of HIV and hepatitis C

A recent article looked at different strategies for identifying undiagnosed hepatitis C virus (HCV), most of which did not work.1 A screening approach, randomly sampling over 5000 people registered with primary care teams in Catalonia, resulted in a 4% response rate. After sending 200 letters per week for 8 months, one new case of HCV was identified. A second approach involved placing posters and leaflets in clinics. This attracted around 70 people to test from a target population of 20 000, and also identified one new case of HCV. The third approach used laboratory records to target people with raised transaminases and unknown HCV antibody status and invite them for testing. This strategy identified 291 individuals at risk, of whom two were new HCV-positive cases. From these results, population-based screening approaches do not seem useful. The third strategy, which also had a low yield overall, was simply a structured approach to following up on unexplained abnormal laboratory test results. Reducing the undiagnosed fraction of HCV remains a …