A review of general hepatitis C virus lookbacks in Canada.
ABSTRACT This article reviews the Canadian experience with general hepatitis C virus (HCV) lookback programmes.
Comprehensive literature searches were conducted in PubMed, Medline, HealthSTAR and EMBASE. In addition, bibliographic searches were performed on all retrieved articles, and provinces were contacted to determine whether they had performed general HCV lookbacks.
Of the seven Canadian general HCV lookbacks identified, two focused specifically on the paediatric population. The proportion of transfused patients presumed to be alive varied from 48.9 to 97.5%. Between 55.3 and 99.1% of letters were successfully delivered. The proportion of patients tested for HCV and subsequently found to be HCV positive varied considerably (66.2-80.4% and 0.9-5.0%, respectively). Newly diagnosed patients represented 42-58% of cases identified.
The Canadian general HCV lookback experience successfully identified previously undiagnosed HCV-positive patients, but the resources required to notify patients are high and the yield is relatively low. The effectiveness may be greatest in the paediatric population.
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ABSTRACT: To explore the impact of the differences in baseline characteristics between immigrants with chronic hepatitis C (CHC) and native-born patients on the prognosis of advanced fibrosis. A retrospective cohort study was conducted in 318 patients (including 128 immigrants) with CHC and advanced fibrosis attending a tertiary referral clinic. Patients' medical records were reviewed to collect data describing immigrant status, baseline characteristics, and liver-related clinical outcomes. Kaplan-Meier (KM) analyses and Cox proportional-hazards regression analyses were performed to explore the differences between the two groups with respect to clinical outcomes. Relative to native-born patients, immigrant patients were older, more likely to be female, and more likely to be Asian. Immigrants were less likely to be heavy drinkers, heavy smokers, injection drug users, and more likely to have type 2 diabetes. KM analyses indicated that immigrant patients had a significantly higher risk of hepatocellular carcinoma (HCC) than Canadian-born patients (P = 0.005). Univariate Cox proportional-hazards analyses indicated that immigrant status (hazard ratio (HR) 2.22; P = 0.006), age (HR 1.07; P < 0.001), heavy drinking (HR 2.69; P = 0.001), heavy smoking (HR 2.03; P = 0.019), and type 2 diabetes (HR 2.06; P = 0.011) were significantly associated with the risk of HCC. Multivariable Cox proportional-hazards analyses showed that immigrant status was not an independent risk factor for HCC (HR 1.37; P = 0.318) after adjusting for age and type 2 diabetes. Older age and higher prevalence of type 2 diabetes accounted for the increased risk of HCC among immigrant patients with CHC and advanced fibrosis.Journal of Viral Hepatitis 08/2012; 19(8):574-80. · 3.08 Impact Factor
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ABSTRACT: Background: Prevalence estimates contribute to our understanding of the magnitude of a particular health condition and in planning appropriate public health interventions. Objective: To estimate the prevalence of chronic Hepatitis C virus (HCV) infection, anti-HCV-positive status (anti-HCV) and the proportion of undiagnosed HCV infections in Canada. Methods: A combination of back-calculation and workbook methods was used. The back-calculation method estimated prevalent chronic HCV infection and the proportion undiagnosed using the Canadian Cancer Registry’s data on hepatocellular carcinoma reported between 1992 and 2008 and the Canadian Notifiable Disease Surveillance System’s data on Hepatitis C virus (HCV) cases reported between 1991 and 2009 in a Markov multi-state disease progression model with parameters adjusted to Canada. The workbook method divided the total population of Canada into population subsets and developed estimates of population size and anti-HCV prevalence for each. Sub-population size estimates were multiplied by anti-HCV prevalence measures to calculate the prevalence of anti-HCV by sub-population. A measure of spontaneous clearance was used to estimate the number of persons with chronic HCV from estimates of the number of anti-HCV-positive persons. Results: The back-calculation method estimated the prevalence of chronic HCV infection at 0.64% and the proportion of undiagnosed chronic HCV infection at 44% in 2011. The workbook method estimated the anti-HCV prevalence at 0.96% (plausibility range: 0.61% to 1.34%) and chronic HCV infection at 0.71% (0.45 – 0.99%). Interpretation: By combining mid-point estimates from both methods, it is estimated that between 0.64% to 0.71% of the overall Canadian population was living with chronic HCV infection in 2011 and 44% of these individuals were undiagnosed.Canadian Communicable Disease Report. 12/2014; 40(19):429-436.