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Abstract Details
Developing and Piloting a Standardized European Protocol for Hepatitis C Prevalence Surveys in the General Population (2016-2019)
Front Public Health. 2021 May 28;9:568524. doi: 10.3389/fpubh.2021.568524. eCollection 2021.
Ida Sperle12, Stine Nielsen3, Viviane Bremer1, Martyna Gassowski1, Henrikki Brummer-Korvenkontio4, Roberto Bruni5, Anna Rita Ciccaglione5, Elena Kaneva6, Kirsi Liitsola4, Zlatina Naneva6, Tanya Perchemlieva6, Enea Spada5, Salla E Toikkanen4, Andrew J Amato-Gauci7, Erika Duffell7, Ruth Zimmermann1
Author information
1Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
4Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland.
5Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy.
6Regional Health Inspectorate, Stara Zagora, Bulgaria.
7European Centre for Disease Prevention and Control, Stockholm, Sweden.
Abstract
Background: A robust estimate of the number of people with chronic hepatitis C virus (HCV) infection is essential for an appropriate public health response and for monitoring progress toward the WHO goal of eliminating viral hepatitis. Existing HCV prevalence studies in the European Union (EU)/European Economic Area (EEA) countries are heterogeneous and often of poor quality due to non-probability based sampling methods, small sample sizes and lack of standardization, leading to poor national representativeness. This project aimed to develop and pilot standardized protocols for undertaking nationally representative HCV prevalence surveys in the general adult population. Methods: From 2016 to 2019 a team from the Robert Koch-Institute contracted by the European Centre for Disease Prevention and Control synthesized evidence on existing HCV prevalence surveys and survey methodology and drafted a protocol. The methodological elements of the protocol were piloted and evaluated in Bulgaria, Finland and Italy, and lessons learnt from the pilots were integrated in the final protocol. An international multidisciplinary expert group was consulted regularly. Results: The protocol includes three alternative study approaches: a stand-alone survey; a "nested" survey within an existing health survey; and a retrospective testing survey approach. A decision algorithm advising which approach to use was developed. The protocol was piloted and finalized covering minimum and gold standards for all steps to be implemented from sampling, data protection and ethical issues, recruitment, specimen collection and laboratory testing options, staff training, data management and analysis and budget considerations. Through piloting, the survey approaches were effectively implemented to produce HCV prevalence estimates and the pilots highlighted the strengths and limitations of each approach and key lessons learnt were used to improve the protocol. Conclusions: An evidence-based protocol for undertaking HCV prevalence serosurveys in the general population reflecting the different needs, resources and epidemiological situations has been developed, effectively implemented and refined through piloting. This technical guidance supports EU/EEA countries in their efforts to estimate their national hepatitis C burden as part of monitoring progress toward the elimination targets.