Canadian Task Force on Preventive Health Care (current guideline, 2017) | We recommend against screening for HCV in adults who are not at elevated risk (strong recommendation, very low-quality evidence). This recommendation applies only to adults who are not at elevated risk for HCV. It does not apply to pregnant women or adults who are at elevated risk for hepatitis C, such as individuals with current or history of injection drug use; individuals who have been incarcerated; individuals who were born, travelled or resided in HCV-endemic countries; individuals who have received health care where there is a lack of universal precautions; recipients of blood transfusions, blood products or organ transplant before 1992 in Canada; patients on hemodialysis; individuals who have had needle-stick injuries; individuals who have engaged in other risks sometimes associated with HCV exposure, such as high-risk sexual behaviours, homelessness, intranasal and inhalation drug use, tattooing, body piercing or sharing sharp instruments or personal hygiene materials with someone who is HCV positive; and anyone with clinical clues suspicious for HCV infection. |
US Centers for Disease Control and Prevention (1998) (95) | The Centers for Disease Control and Prevention recommends routine testing of those at high risk, defined as history of injection drug use, those at risk of health care–associated transmission, individuals with HIV, those with a recognized exposure, or those who are concerned. This is an unrated risk-based recommendation, based on expert opinion related to prevalence in risk groups |
College of Family Physicians of Canada and the Public Health Agency of Canada (2009) (14) | The College of Family Physicians of Canada and Public Health Agency of Canada guideline recommends screening anyone with risk behaviours or potential exposures, defined as injection drug use, incarceration, exposure in a high-prevalence region (born, travelled or resided), health care–associated transmission, higher-risk sexual behaviour, tattoos or body piercing, or ceremonial rituals requiring skin piercing done with suspect infection control, etc. Individuals with any of the above risk factors and the following should also be tested: abnormal ALT, HIV, hepatitis B, non-Hodgkin lymphoma, signs of chronic liver, etc. These are unrated risk-based recommendations, based on expert opinion. |
UK National Screening Committee (2011) (91) | The National Screening Committee recommended against a national screening program for HCV among people of ethnic minorities who are born outside the UK. This is an unrated recommendation based on a lack of randomized controlled trial data on the effectiveness of screening programs to reduce morbidly and mortality in addition to other areas related to program initiation. |
Canadian Collaboration for Immigrant and Refugee Health (2011) (93) | The Canadian Collaboration for Immigrant and Refugee Health recommends screening all immigrants and refugees from regions with prevalence of disease ≥ 3% (this excludes South Asia, Western Europe, North America, Central America and South America). This prevalence-based recommendation is based on moderate-quality evidence factoring in increased risk of death from viral hepatitis and hepatocellular carcinoma in immigrants and refugees compared with the general population. |
US Centers for Disease Control and Prevention (2012) (96) | The Centers for Disease Control and Prevention augmented its 1998 guideline by recommending one-time testing without prior ascertainment of HCV risk for adults born between 1945 and 1965. This is a strong cohort-based recommendation based on moderate-quality evidence that these benefits outweigh harms: attainment of SVR, and SVR’s association with reduced risk of hepatocellular carcinoma and all-cause mortality. Anecdotal evidence was also considered: undergoing liver biopsy, false-positive tests, anxiety, treatment access and effect of HCV status on insurance and employment. Cohort chosen was based on prevalence estimates. |
Immigration, Refugees and Citizenship Canada (2013) (90) | Immigration, Refugees and Citizenship Canada recommends one-time screening of those with risk factors such as injection drug use; health care–associated transmission, including occupational exposure; higher-risk sexual behaviour; tattoos or body piercing; former incarceration; children born to mothers with chronic hepatitis C infection; those with signs or symptoms of liver disease, active tuberculosis, HIV or syphilis, etc., with particular emphasis on those from endemic countries: Egypt, Pakistan and China are specifically mentioned. These are unrated risk-based recommendations, based on expert opinion and provincial recommendations (British Columbia) and the World Health Organization. |
National Institute for Health and Care Excellence (2013) (88) | The National Institute for Health and Care Excellence recommends one-time testing of those at high risk including injection drug users, people at risk of health care–associated transmission, migrants from countries with a 2% or greater prevalence, incarcerated persons, the homeless, children or youth in care homes, HIV-positive men who have sex with men, etc. This is an unrated risk-based recommendation, based on moderate evidence that safe and responsible injecting practices are employed by injection drug users to avoid the transmission of hepatitis C, and based on inference-derived evidence (expert opinion) on studies of hepatitis B. |
US Preventive Services Task Force (2013) (94) | The US Preventive Services Task Force recommends one-time screening of adults born between 1945 and 1965 and those at high risk of infection as a result of potential exposure before universal blood screening. It also recommends periodic screening of individuals with a history of risk exposure, such as injection drug users. This is a grade B cohort- and risk-based recommendation, based on adequate evidence that harms are small, moderate benefit of screening test accuracy studies and moderate certainty of SVR as an intermediate outcome and its link to reduced hepatocellular carcinoma and mortality. The review did not find evidence on effect of current treatments and long-term outcomes, or evidence on benefit of screening asymptomatic adults in reducing morbidity or mortality. Cohort chosen was based on prevalence estimates. |
Scottish Intercollegiate Guidelines Network (2013) (89) | The Scottish Intercollegiate Guidelines Network recommends one-time testing of individuals who might benefit from knowing their status and those with an excess risk, defined as injection drug users, people at risk of health care–associated transmission, those with HIV, people with tattoos or body piercing done with suspect infection control, elevated ALT, migrants from medium- or high-prevalence countries, etc. Individuals who remain at high risk should be offered annual testing. This is an expert opinion grade D risk-based recommendation, based on prevalence, other guidelines and a few studies on injection drug use. |
World Health Organization (2014) (87) | In low- and middle-income countries, the World Health Organization recommends one-time screening of individuals who are at high risk of HCV, defined broadly to include people at risk of health care–associated transmission, individuals with HIV, injection drug users, etc. This is a strong risk-based recommendation, based on moderate-quality evidence of the influence of media and practitioners to increase uptake of screening. Studies did not consider harms and found no direct evidence showing that targeted testing increased SVR or reduced mortality. |
Gastroenterological Society of Australia (2016) (92) | The Gastroenterological Society of Australia recommends annual screening of HCV-seronegative people with risk factors for HCV transmission, defined as injection drug users, sex workers, people with tattoos or body piercing, people in custodial settings, people with HIV or hepatitis B, people who have evidence of liver disease, migrants from high-prevalence regions, etc. This is an expert opinion grade A1 risk-based recommendation based on prevalence and modelled reduction in liver-related deaths as a result of achieving SVR. |
World Health Organization (2016) (86) | This recommendation is identical to 2014 recommendations. In low- and middle-income countries, the World Health Organization recommends one-time screening of individuals who are at high risk of HCV, defined broadly to include people at risk of health care–associated transmission, individuals with HIV, injection drug users, etc. This is a strong risk-based recommendation, based on moderate-quality evidence on the influence of media and practitioners to increase uptake of screening. Studies did not consider harms and found no direct evidence showing that targeted testing increased SVR or reduced mortality. |
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