People with severe mental illness “priority group” for HCV screening

22 December 2021

2 minutes to read

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People with severe mental illness had a high prevalence of hepatitis C virus, according to the results of a systematic review and meta-analysis published in Journal of Clinical Psychiatry.

“People with [serious mental illness] have a preponderance of risk factors for HCV, including an estimated lifetime prevalence of 16% to 22% of injection drug use, as well as increased incarceration rates compared to non-[serious mental illness] populations, ” Michael Rudi Braude, M.Sc., MBBS, from the Department of Gastroenterology and Hepatology at Monash Health in Australia, and colleagues wrote. “Although these risk factors may tend to overlap with other key and decentralized HCV elimination strategies, such as [opioid substitution therapy] and prison programs, [serious mental illness] populations as a whole require targeted strategic engagement.

Researchers conducted a meta-analysis of the prevalence of HCV in people with severe mental illness, as well as a systematic review of barriers to care. They hypothesized that individual complications and community transmission of HCV could be addressed through improved health care strategies. They searched five databases between April 21, 1989 and July 1, 2020, looking for articles published in English. They crossed the terms “hepatitis C virus”, “HCV”, “HCV seroprevalence” and “HCV prevalence” with “severe mental illness”, “severe mental illness”, “psychiatric illness”, “mental illness”. And “psychiatric illness”. the patients.”

In the final analysis, Braude and colleagues included 36 publications from large-scale prospective and retrospective studies with cross-sectional HCV screening in people with severe mental illness aged 18 years or older.

The results showed a combined HCV prevalence of 8% (95% CI, 6% to 9%). A sub-analysis of prospective studies involving a total of 9,015 people showed a comparable prevalence (8%; 95% CI, 5% to 11%) to that of retrospective studies involving a total of 289,246 people ( 8%; 6% – ten%). People with severe mental illness had an HCV prevalence three to 11.3 times that of controls.

The results of the semi-qualitative analysis of seropositive cases showed that 20% to 58.1% did not have an identified HCV risk factor, 12.5% ​​to 100% of cases had not been previously reported as infected with HCV and 57% to 96.6% of people with severe mental illness were susceptible. HCV screening.

“A first step is to recognize [serious mental illness] as a priority group for HCV testing and adopt widespread testing with an emphasis on a patient-centered approach, ”Braude and colleagues wrote. “This recognizes that screening for BBV is highly acceptable in people with [serious mental illness] and that cross-sectional screening is effective in identifying previously undiagnosed HCV. In terms of overcoming existing barriers, innovative models of care that maximize the opportunities for de-stigmatized screening and minimize the complexity of follow-up are likely to result in an improved cascade of care and improved health outcomes.

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