Evaluation of a risk assessment questionnaire to assist hepatitis C screening in the general population

F Zuure; U Davidovich; G Kok; A C Depla; C Hoebe; A van den Hoek; P L Jansen; P van Leeuwen-Gilbert; C J Weegink; R A Coutinho; M Prins

doi:10.2807/ese.15.15.19539-en

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Evaluation of a risk assessment questionnaire to assist hepatitis C screening in the general population
F Zuure¹ , U Davidovich¹ , G Kok² , A C Depla³ , C Hoebe⁴ , A van den Hoek^1,5 , P L Jansen⁶ , P van Leeuwen-Gilbert⁷ , C J Weegink⁶ , R A Coutinho^5,8 , M Prins^1,5
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Affiliations: ¹ Cluster Infectious Diseases, Department of Research, Amsterdam Public Health Service, Amsterdam, the Netherlands ² School of Psychology, University of Maastricht, Maastricht, the Netherlands ³ Department of Gastroenterology, Slotervaart Hospital Amsterdam, the Netherlands ⁴ South Limburg Public Health Service, Geleen, the Netherlands ⁵ Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (University of Amsterdam), Amsterdam, the Netherlands ⁶ Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands ⁷ National Hepatitis Centre, Amersfoort, the Netherlands ⁸ National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, the Netherlands

Correspondence:
F Zuure
fzuure ggd.amsterdam.nl
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Citation style for this article: Zuure F, Davidovich U, Kok G, Depla A C, Hoebe C, van den Hoek A, Jansen P L, van Leeuwen-Gilbert P, Weegink C J, Coutinho R A, Prins M. Evaluation of a risk assessment questionnaire to assist hepatitis C screening in the general population. Euro Surveill. 2010;15(15):pii=19539. https://doi.org/10.2807/ese.15.15.19539-en Received: 13 Jul 2009

Abstract

Many individuals with hepatitis C virus (HCV) infection are undiagnosed. This study evaluates a risk assessment questionnaire, developed for use online to target blood-screening for HCV. Two hundred and eighty-nine patients with known HCV status completed a written questionnaire on prominent HCV risk factors. Questionnaires generated advice to seek testing if at least one risk factor was reported. Agreement of the testing advice with the HCV status of respondents was evaluated. Subsequently, we validated our questionnaire among 985 patients of an outpatient clinic for sexually transmitted infections. The post-test-probability-of-disease (PTPD) and diagnostic gain (PTPD minus prior probability of disease) were calculated. The questionnaire's sensitivity and specificity were 84.6% and 63.8%, respectively, and higher in the STI clinic patients. The PTPD of positive testing advice was 72.5% given HCV prevalence of 53.0%, yielding a diagnostic gain of 19.5%. Applying the estimated prevalence in the general Dutch population (0.1-0.4%), and the anticipated prevalence in the online project (1.0-6.0%), yielded diagnostic gains of 0.13-0.53% and 1.3-7.0%, respectively. We conclude that our questionnaire succeeded in selecting at-risk individuals as its testing advice agreed well with the HCV status. We suggest that the questionnaire be used online as a selection tool for HCV blood-screening in the general population. .