HEPscreen > What can we do about it? > Ways to offer screening > A repository of good practice screening projects

A repository of good practice screening projects

The table below shows the good practice screening studies from Europe that the HEPscreen team has identified in the scientific literature and from other online sources. There is a short summary of the study with a ‘Read More’ option where the abstract and link to the full text are provided.

Type Setting Target group Virus Number screened Country & year
Outreach Testing sessions at 52 different sites using oral fluid testing South Asian communities HBV-HCV 4998 UK, England, 2008(?)
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Uddin G, Shoeb D, Solaiman S, Marley R, Gore C, et al. Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin. J Viral Hepat. 2010;17(5):327-35.
Email: g.r.foster@qmul.ac.uk
http://www.ncbi.nlm.nih.gov/pubmed/20002307

Background & Aims
The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown.

Methods
We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing.

Results
The overall prevalence of antihepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%–0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively.

Conclusions
Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.Keywords: hepatitis B, hepatitis C, immigrants, prevalence.

Opportunistic Mass multi-center HBV-screening study comparing different testing practices Persons potentially eligible for HBV-testing in healthcare centers HBV 3929 France, 2010-2011
Read more
Bottero J, Boyd A, Lemoine M, Carrat F, Gozlan J, et al. Current state of and needs for hepatitis B screening: results of a large screening study in a low-prevalent, metropolitan region. PLoS One. 2014;9(3):e92266.
Email: julie.bottero@sat.aphp.fr
Free full text: http://www.ncbi.nlm.nih.gov/pubmed/24663387

Background & Aims
In low hepatitis B virus (HBV)-prevalent countries, most HBV-infected persons are unaware of their status. We aimed to evaluate whether (i) previous HBV-testing, (ii) physicians decision to screen, and (iii) CDC’s recommendations identified infected individuals and which risk-factor groups needing testing.

Methods
During a mass, multi-center HBV-screening study from September 2010-August 2011, 3929 participants were screened for hepatitis B surface antigen (HBsAg), anti-HBs and anti-Hepatitis B core antibodies (anti-HBcAb). Questions on HBV risk-factors and testing practices were asked to participants, while participants’ eligibility for HBV-testing was asked to study medical professionals.

Results
85 (2.2%) participants were HBsAg-positive, while 659 (16.8%) had either resolved HBV infection or isolated anti-HBcAb. When comparing practices, HBV-testing was more likely to occur in HBV-infected participants if Centers for Disease Control and Prevention (CDC) recommendations were used (Sensitivity = 100%, 95%CI: 95.8–100) than physicians’ discretion (Sensitivity = 87.1%, 95%CI: 78.0–93.4) or previous HBV-test (Sensitivity = 36.5%, 95%CI: 26.3–47.6) (p,0.0001). Nevertheless, many non-infected individuals would still have been screened using CDC-recommendations (Specificity = 31.1%, 95%CI:29.6–32.6). Using multivariable logistic regression, HBsAg-positive status was significantly associated with the following: males, originating from high HBV-endemic region, contact with HBV-infected individual, without national healthcare, and intravenous-drug user (IDU). Of these risk-factors, physician’s discretion for testing HBV was not significantly associated with participants’ geographical origin or IDU.

Conclusions
Missed opportunities of HBV-screening are largely due to underestimating country of origin as a risk-factor. Applying CDC-recommendations could improve HBV-screening, but with the disadvantage of many tests. Further development of HBV-testing strategies is necessary, especially before severe disease occurs.
Opportunistic Primary care centres Patients with a migrational background HBV-HCV 1313 Germany, 2010-2012
Read more

Heidrich B, Cetindere A, Beyaz M, Stahmeyer JT, Basaran MM, Braynis B, et al. High prevalence of hepatitis markers in immigrant populations: a prospective screening approach in a real-world setting. European journal of gastroenterology & hepatology 2014;26(10): 1090-1097.
http://www.ncbi.nlm.nih.gov/pubmed/25076065


Background
Immigrant populations are believed to be more frequently infected with hepatitis viruses. However, limited unbiased data are available on immigrants outside of academic centres. Therefore, the aim of this study was to perform large-scale screening for hepatitis markers in primary care centres treating mainly individuals with a migrational background in Germany.

Methods
Between November 2010 and January 2012, we prospectively screened 1313 individuals treated by general practitioners at eight primary care centres in North-western Germany. Patients were eligible if they or their parents were not born in Germany. Serological screening for hepatitis B core protein antibodies, hepatitis B surface antigens (HBsAgs), and anti-hepatitis C virus antibodies was performed in each individual. HBsAg-positive and anti-hepatitis C virus-positive patients were further tested for molecular markers of viral replication.

Results
The mean age was 49.1±15.8 years. Of the patients, 45.7% were male; 87.3% had migrated to Germany from the Eastern Mediterranean area and 12.0% from Eastern Europe. Of the patients, 32.5% tested positive for hepatitis B core protein antibodies. HBsAgs were found in 3.6% of patients. Overall, hepatitis B virus DNA was detected in 2.2% of patients. Markers for hepatitis C virus infection were found in an almost similar high frequency (1.9%). Individuals with migrational background showed significant deficits in knowledge on general routes of transmission.

Conclusions
Hepatitis virus infections are indeed significantly more prevalent in immigrant populations as compared with the general German population. These data underline the importance of introducing screening programs in this particular risk group.
Outreach  Testing sessions in mosques and community centres  South Asian community HBV-HCV  1288 UK, Scotland, 2009-2010
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O’Leary MC, Sarwar M, Hutchinson SJ, Weir A, Schofield J, et al. The prevalence of hepatitis C virus among people of South Asian origin in Glasgow – results from a community based survey and laboratory surveillance. Travel Med Infect Dis. 2013;11(5):301-9.
Email: maureen.oleary@lshtm.ac.uk
http://www.ncbi.nlm.nih.gov/pubmed/24007935

Background & Aims
South Asians often present late with HCV or HBV related liver disease which could have been avoided with early diagnosis and subsequent treatment; however the prevalence of HCV/HBV among South Asians in Glasgow is not known. Accordingly, to inform the need for case finding among this group we aimed to examine the prevalence of Hepatitis C virus (HCV) among South Asians living in Glasgow.

Methods
A community-based survey recruited individuals at six mosques and four community centres serving the South Asian community during 2009-2010; participants had predominantly never been HCV tested. Laboratory surveillance data involving all individuals tested for HCV during 1993-2009 were examined and South Asians were identified using Nam Pehchan software.

Results
In the community-based survey, 2.6% of 1288 participants tested HCV-antibody positive; the prevalence ranged from 0.6% among those born in the UK to 3.1% among those born in Pakistan. The odds of testing HCV-antibody positive were significantly raised among those who had surgery in South Asia (aOR: 5.0, 95% CI: 2.0-12.3) and had either medical/dental
treatment or an injection in South Asia (aOR: 2.2, 95% CI: 1.0-5.0). Of 6404 South Asians identified from laboratory surveillance data, 9.3% tested HCV positive. An estimated 38% (330/870) of HCV-infected South Asians living in Glasgow remain undiagnosed.

Conclusions
South Asians living in Glasgow, particularly those born outside the UK are at greater risk of HCV infection than the general population. Efforts to increase awareness and testing in this population are warranted.
Outreach  Education and screening sessions at outreach locations  Chinese and South Asian communities HBV-HCV  1126 UK, England, 2011(?)
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McPherson S, Valappil M, Moses SE, Eltringham G, Miller C, et al. Targeted case finding for hepatitis B using dry blood spot testing in the British-Chinese and South Asian populations of the North-East of England. J Viral Hepat. 2013;20(9):638-44.
Email: stuart.mcpherson@nuth.nhs.uk
http://www.ncbi.nlm.nih.gov/pubmed/23910648

Background & Aims
Chronic infection with the hepatitis B virus (HBV) is a frequent cause of cirrhosis and liver cancer. Targeted HBV screening is recommended by the Centre for Disease Control (CDC) and Prevention for subjects born in countries with >2% HBV prevalence. However, there are no UK guidelines.

Methods
Here, we applied the (CDC) recommendations to the British–Chinese and British–South Asian community of North-East (NE) England. British–Chinese and South Asian subjects were invited to attend for HBV education and screening sessions held in community centres. Hepatitis B surface antigen (HBsAg) and hepatitis B core total antibody
(HBcAb) were tested with dry blood spot tests. South Asians were also tested for hepatitis C antibody (HCVAb).

Results
A total of 1126 subjects (606 Chinese and 520 South Asian) were screened. Sixty-two (5.5%) were HBsAg positive. Ten of these reported a previous diagnosis of HBV. The prevalence of HBsAg positivity was 4.6% when previously diagnosed individuals were excluded. The HBsAg prevalence was significantly higher in the Chinese subjects compared with South Asians (8.7% VS. 1.7% P < 0.001). In Chinese subjects, HBsAg positivity was highest in subjects born in Vietnam (17.4%), followed by China (11%), Hong Kong (7.8%) and the UK (6.7%). Subjects from Pakistan had the highest HBsAg and HCV Ab prevalence in the South Asians (3.1% and 1.8%, respectively). Ten percentage of HBsAg positive patients who had follow-up assessment had active disease requiring antiviral treatment.

Conclusions
Undiagnosed HBV infection was above the 2% threshold for screening suggested by the CDC in the British–Chinese and Pakistani community of NE England, which provides evidence for a UK HBV-targeted screening programme.Keywords: case finding, dry blood spot testing, hepatitis B, hepatitis C, screening.
Outreach  Disease awareness sessions with free HBV testing at outreach locations  Chinese community HBV-HCV  1090  The Netherlands, 2009
Read more
Veldhuijzen IK, Wolter R, Rijckborst V, Mostert M, Voeten HA, Cheung Y, et al. Identification and treatment of chronic hepatitis B in Chinese migrants: Results of a project offering on-site testing in Rotterdam, The Netherlands. J Hepatol. 2012;57(6):1171-6.
Email: ik.veldhuijzen@rotterdam.nl
http://www.ncbi.nlm.nih.gov/pubmed/22885717

Background & Aims
Migrants born in countries where hepatitis B is endemic are a risk group for chronic hepatitis B virus (HBV) infection. Treatment options have improved, but due to the asymptomatic nature of chronic HBV infection, the majority of patients remain unidentified.

Methods
In 2009, a campaign targeting the Chinese community was held in the city of Rotterdam, The Netherlands. The campaign combined disease awareness activities with free HBV testing at outreach locations. Chronically HBV infected patients were referred to specialist care based on a referral guideline. Before and after the campaign, knowledge of chronic hepatitis B was measured through questionnaires in a convenience sample of the target population (n = 285 and n = 277).

Results
In a period of 3 months, 13 outreach activities took place and 1090 Chinese migrants were tested for HBV. Forty-nine percent had serological signs of a past or recent HBV infection and 8.5% (n = 92) were chronically infected. Thirty-eight percent (n = 35) of chronically infected patients were referred for evaluation by a specialist and of these, 15 started antiviral treatment within 1 year of follow-up. Before the campaign, 55% answered correctly to 6 or more out of 10 knowledge items. Knowledge was positively associated with educational level. After the campaign, an increase in knowledge was observed in participants with low levels of education.

Conclusions
Chinese migrants could be reached with an outreach campaign, and on-site testing was well accepted. A high prevalence of chronic HBV infection was found and referral to specialist care and initiation of treatment was successful.
Opportunistic  GP practices with sizeable ‘non-UK born’ population People born outside the UK HBV-HCV  1012  UK, England, 2009-2010
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al-Lami Z, Powell S, Bradshaw S, Lambert A, Mutimer D, Rouse A. Simple intervention to improve detection of hepatitis B and hepatitis C in general practice. 2009
Presentation at RCGP Annual Primary Care Conference 2011
Download presentation
Invitation based  Personal invitation to attend information and testing events at the hospital  Migrants from Afghanistan, Iran, Iraq, former Soviet States, Vietnam HBV-HCV  959  The Netherlands, 2011
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Richter C, Ter Beest G, Gisolf EH, VAN Bentum P, Waegemaekers C, et al. Screening for chronic hepatitis B and C in migrants from Afghanistan, Iran, Iraq, the former Soviet Republics, and Vietnam in the Arnhem region, The Netherlands. Epidemiol Infect. 2014;142(10):2140-6.
Email: CRichter@alysis.nl
http://www.ncbi.nlm.nih.gov/pubmed/24398373

Background & Aims
Migrants born in hepatitis B virus (HBV) and hepatitis C virus (HCV) endemic countries are at increased risk of being infected with these viruses. The first symptoms may arise when liver damage has already occurred. The challenge is to identify these infections early, since effective treatment has become available.

Methods
In 2011 we conducted a screening project in first-generation migrants (FGMs) born in Afghanistan, Iran, Iraq, the former Soviet Republics, and Vietnam and living in Arnhem and Rheden. All participants were offered free blood screening for HBV and HCV.

Results
In total 959 participants were tested, with the country of origin known for 927, equating to 28.7% of all registered FGMs from the chosen countries. Nineteen percent (n=176) had
serological signs of past or chronic HBV infection and 2.2% (n=21) had chronic HBV infection. The highest prevalence of chronic HBV infection was found in the Vietnamese population (9.5%, n=12). Chronic HCV was found in two persons from the former Soviet Republics and one from Vietnam. Twenty-four percent (n=5) of the newly identified patients with chronic HBV and one of the three patients with chronic HCV received treatment. Three of the patients, two with HCV and one with HBV, already had liver cirrhosis. The highest (9.5%) HBV prevalence was found in FGMs from Vietnam, indicating a high need for focusing on that particular immigrant population in order to identify more people with silent HBV infection.

Conclusions
The fact that three patients already had liver cirrhosis underlines the necessity of early identification of HBV and HCV infection in risk groups.Key words: Hepatitis B, hepatitis C, prevalence of disease, estimating, screening programme.
Outreach  Educational meetings with free screening test at outreach locations  Turkish community HBV-HCV  709  The Netherlands, 2009
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Richter C, Beest GT, Sancak I, Aydinly R, Bulbul K, et al. Hepatitis B prevalence in the Turkish population of Arnhem: implications for national screening policy? Epidemiol Infect. 2012;140(4):724-30.
Email: crichter@alysis.nl
http://www.ncbi.nlm.nih.gov/pubmed/21740610

Background & Aims
Despite the increased prevalence of hepatitis B and C in most migrant groups in The Netherlands, a national screening policy for these infections is not available. In order to estimate the prevalence of hepatitis B and C in the largest group of first-generation migrants (FGM) in The Netherlands, we conducted a screening project in the Turkish community of Arnhem.

Methods
In a separate project we identified patients from the target population with chronic hepatitis B and C from hospital records (1990–2008). Educational meetings concerning hepatitis were organized, with all participants being offered a blood screening test. Participants were tested for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis C virus (anti-HCV). In total 709 persons were tested, a complete dataset was available for 647 patients.

Results
We found that 3.0% and 0.4% of Turkish FGM aged >24 years in Arnhem had active hepatitis B, defined as HBsAg positive, and tested positive for anti-HCV, respectively. The hospital records revealed another 32 patients, 28 with hepatitis B and four with hepatitis C representing 0.7% for hepatitis B and 0.1% for hepatitis C in relation to the total number of Turkish FGM in Arnhem.

Conclusions
We believe that active hepatitis screening of FGM from Turkey should be part of the national health policy as it will benefit the individual and public health.
Invitation based  Personal invitation for online intervention with the option to request a lab form for a free blood test at a community health centre  Turkish community HBV  623  The Netherlands, 2010
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van der Veen YJ, van Empelen P, de Zwart O, Visser H, Mackenbach JP, Richardus JH. Cultural tailoring to promote hepatitis B screening in Turkish Dutch: a randomized control study. Health Promot Int. 2013.
Email: ik.veldhuizen@rotterdam.nl
http://www.ncbi.nlm.nih.gov/pubmed/23574695

Background & Aims
Hepatitis B virus (HBV) infections are an important health problem in Turkish migrants in the Netherlands. This study describes the effectiveness of a culturally
tailored internet intervention promoting HBV screening in Turkish migrants.

Methods
Turkish migrants, aged 16–40 years old, could participate in an online intervention
offering either: (i) behaviourally plus culturally tailored (BCT) information; (ii) behaviourally tailored (BT) information or (iii) generic information (GI).
Subsequently, free HBV screening was offered.

Results
Out of 10.069 invited persons, 1512 (15%) logged in on the website and 623 people were tested. Screening uptake was 44% in the BCT group, 46% in the GI group and 44% in group BT. The BCT group showed favourable intervention effects for scores on determinants of screening when compared with baseline scores and BT.

Conclusions
Although BCT did show favourable intervention effects for several determinants
addressed in the intervention, we were not able to demonstrate the added value of BCT on screening uptake.Paper on the design of the intervention (free full text): http://www.ncbi.nlm.nih.gov/pubmed/21795303
Study protocol (free full text): http://www.ncbi.nlm.nih.gov/pubmed/21054830
Outreach  Educational sessions with free screening test at outreach locations  Egyptian migrants HBV-HCV  465  The Netherlands, 2009-2010
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Zuure FR, Bouman J, Martens M, Vanhommerig JW, Urbanus AT, et al. Screening for hepatitis B and C in first-generation Egyptian migrants living in the Netherlands. Liver Int. 2013;33(5):727-38.
Email: fzuure@ggd.amsterdam.nl
http://www.ncbi.nlm.nih.gov/pubmed/23448397

Background & Aims
Egypt has high prevalence of hepatitis C virus (HCV) infection and intermediate prevalence of hepatitis B virus (HBV) infection; however, infection prevalence among Egyptian migrants is unknown. Considering the asymptomatic onset and development of disease in chronically-infected patients, many may remain undiagnosed. Aims: To evaluate an HCV- and HBV-screening programme designed to identify undetected infections among first-generation Egyptian migrants in Amsterdam, the Netherlands.

Methods
In 2009 and 2010, viral hepatitis educational and screening sessions were established at Egyptian meeting places. Data regarding demographics and HCV risk factors were collected. Chronically infected participants were referred and followed up. Phylogenetic analyses were used to ascertain the geographic origin of infections.

Results
Eleven of 465 (2.4%; 95% CI = 1.3–4.2%) migrants had HCV antibodies; 10/11 were HCV RNA positive. All had genotype 4a, and strains were typical of those of Egypt and the Middle East. Older age and exposure to parenteral antischistosomal therapy (PAT) were significantly associated with HCV. Anti-HBc prevalence was 16.8% (95% CI = 13.7–20.4%); HBsAg prevalence was 1.1% (95% CI = 0.5– 2.5%). All had genotype D, typical of those of the Middle East. Most (9/10 HCV; 3/5 HBV) chronic infections were newly diagnosed; four of the HCV-infected individuals started treatment.

Conclusions
Anti-HCV and HBsAg prevalence among Egyptian migrants was lower compared with the general Egyptian population, but higher than the general population of Western countries. Phylogenetic analyses suggest that all infections were from the region of origin. HCV-screening programmes should target first-generation Egyptian migrants, especially those of older age and those who received PAT.
Opportunistic Dedicated nurse-led Slovak clinic in a Primary Care Practice. Screening offered as part of routine health check for newly registered patients.  Slovak-Roma community HBV  436  UK, England, 2007-2013
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Gregory A, Vedio A, Stone B, Green S, Bronsdon C. Targeted testing in primary care demonstrates high prevalence of hepatitis B infection within the Slovak-Roma population in Sheffield, UK. J Viral Hepat. 2014 Jul 24.doi: 10.1111/jvh.12287. http://www.ncbi.nlm.nih.gov/pubmed/25056611
Email: alicia.vedio@sheffield.ac.uk
Multiple method via GP  Testing via GP comparing uptake of testing via awareness raising test cards, invitation and opportunistic.  Pakistani community HBV-HCV  223  UK, England, 2010(?)
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Lewis H, Burke K, Begum S, Ushiro-Limb I, Foster G. What is the best method of case finding for chronic viral Hepatitis in migrant communities? BASL 2011. Gut 2011;60:A26.
Email: g.r.foster@qmul.ac.uk
Conference abstract

Background & Aims
The prevalence of chronic viral hepatitis in people born in Pakistan living in the UK is 5% (2.7% Hepatitis C Virus (HCV) and 1.8% Hepatitis B Virus (HBV). Studies from the HPA show an increased risk of end stage liver disease from HCV in people from Pakistan living in the UK. Screening migrants from high prevalence regions (>2%) for HBV is cost effective if screening of 35% of a population is achieved. Given that screening for viral hepatitis in migrants will reduce morbidity, mortality and onward transmission of chronic viral hepatitis, the outstanding question is how should this be done?The aim of this observational study was to evaluate community, and general practice (GP) based approaches to screening migrants for viral hepatitis.

Methods
We distributed 5000 testing cards in Mosques, following an awareness campaign, encouraging people from Pakistan to attend their GP surgery for viral hepatitis testing. In primary care practices we studied two approaches targeting registered Pakistani/British Pakistani patients: an opportunistic approach, whereby patients attending the practice were offered screening for HBV and HCV, and an ‘opt out’ approach, where patients were contacted by letter and invited to opt out of screening. Those who did not ‘opt out’ were telephoned and asked to attend screening clinics.

Results
5000 leaflets were distributed to Mosques but no patients presented to their GP for testing. In the primary care study there were 1163 Pakistani/British Pakistani patients in the ‘opportunistic’ arm. Of these 17 (1.5%) were screened and all were uninfected. In the ‘opt out’ arm there were 1134 eligible patients. It was not possible to screen 524 patients (46%) due to inadequate contact details (38%), previous screening (4%) or incorrectly recorded ethnicity (4%). Of those who could be contacted and were eligible for screening, 37% (223/600) have been screened. 75% of those who made a screening appointment were born in Pakistan, and 25% were British Pakistani patients. 1% of those screened were found to be HBsAg positive and 2.4% were HCV antibody positive.

Conclusions
Community awareness campaigns and leaflets do not directly lead to testing for viral hepatitis in at risk immigrant groups. A direct screening approach is more effective than an opportunistic screening approach in primary care. Inaccurate GP records reduce the efficiency of screening but GP based testing is easy to implement, popular with patients and effective. First generation migrants are more likely to comply with screening which may improve the cost-effectiveness of this approach.
Outreach  Awareness sessions and testing clinics in mosques and a Pakistani women’s centre Pakistani community HBV-HCV  170  UK, Scotland, 2009
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Jafferbhoy H, Miller MH, McIntyre P, Dillon JF. The effectiveness of outreach testing for hepatitis C in an immigrant Pakistani population. Epidemiol Infect. 2012;140(6):1048-53.
Email: kirsty.licence@nhs.net
http://www.ncbi.nlm.nih.gov/pubmed/21854668

Background & Aims
In Scotland, an estimated 1% of the population is infected with hepatitis C virus (HCV). There is ethnic diversity in Scotland, with a large Pakistani sub-population. Our aim was to investigate the prevalence of HCV in an immigrant Pakistani population and effectiveness of an outreach testing intervention.

Methods
We arranged a series of HCV awareness meetings at the mosques and Pakistani Women’s centre in the city of Dundee. Thereafter short-term outreach HCV testing clinics were set up in the same venues. Venous blood samples were obtained and tested for HCV IgG and HbsAg. A short questionnaire was also completed. In total, 177 individuals volunteered for testing, out of an estimated 250 who attended meetings and a total Pakistani population in Dundee of 1723.

Results
Of those tested 170 were Scottish Pakistanis (159 first generation, 11 second generation). There were 145 (85.2%) men. The mean age was 45.11 (± S.D. 16.7) years. Seven (4.1%) individuals in the cohort were anti-HCV positive. Five (2.9%) were found to have HCV RNA by PCR. Only one patient had chronic hepatitis B infection. All patients with positive results were seen in the liver clinic for consideration of treatment.

Conclusions
We have demonstrated that immigrant Pakistanis retain a higher prevalence of HCV compared to the population of their adopted country. Outreach targeted testing in this group can be achieved using religious and cultural gatherings, with only modest investment in staff time.Key words: Ethnic, hepatitis C, Pakistani, Scotland.