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Introduction

Screening programs for transmissible diseases have become a major component of any coherent national and global health strategy. Elimination of viral hepatitis C (HCV) as a major public health threat by 2030 has become one of the main targets assigned by the World Health Organization in their long-term strategy, along with universal access to affordable and effective prevention, care, and treatment services [1]. The use of computer-aided and artificial intelligence in health-related resource management will greatly influence the chance of attaining these goals.

Aims & Methods

Our aim was to comparatively test multiple different design and training approaches for computer-assisted tools used in selecting at-risk populations during a large-scale regional screening for HCV infection. Between September 2020 and January 2023, we prospectively included participants over 40-years of age from the Southwestern region of Oltenia, Romania. All provided written informed consent and were presented with a 12-item rapid questionnaire followed by on-site anti-HCV antibody rapid testing. For the purposes of this study, the anonymized questionnaire answers, age, gender, and provenance of the subjects were collected, along with the result of the antibody testing results. We developed two artificial neural networks (ANN) models in Keras 2.7.0 with Tensorflow (Google, USA) using Python 3.7 (P.S.F., USA). One ANN model had access only to questionnaire answers (ANN1) and the other also included demographic data as inputs (ANN2). We trained each model on two sets of data – one with 15,139 participants (ANN1.1 and 2.1), the other with an additional 14,042 subjects (ANN2.1 and 2.2). All four resulting ANNs were tested on the same 6,226 additional participants’ datasets, comparing their accuracy, sensitivity, specificity, negative and predictive values at five confidence intervals – 0.6, 0.7, 0.8 and 0.9, also accounting for the number of tests needed by the systems each time to find true positives.

Results

The training datasets contained 15,139 and 29,181 subjects, respectively. The total screened population was 35,407, including 6,226 in the test lot (42 HCV positives). Table 1 shows the number of required tests by each ANN model, and the number of true positives. The ANN not accounting for demographic data performed better in predicting a higher number of positives, at lower confidence levels and with a high usage of tests, while the complete model consistently required less tests, with less true positives at lower confidence intervals, but significantly better results at higher confidence intervals. Overall, the most balanced results were obtained by ANN2.2 (all inputs and data) – 69% sensitivity, 56.4% specificity, 1% PPV, 99.6% NPV and 56.5% accuracy at 0.6 and 26.2%, 97.4%, 4.2%, 99.4% and 96.9%, respectively, at 0.9 confidence level.

	ANN1.1		ANN1.2		ANN2.1		ANN2.2
	Tests	Positives	Tests	Positives	Tests	Positives	Tests	Positives
0.6	4486	38	3875	36	3675	28	2723	29
0.7	432	14	528	14	2133	23	1651	24
0.8	53	1	446	14	274	6	352	11
0.9	5	0	28	1	80	0	165	7

Conclusion

The ANN system trained on a larger dataset and accounting for more variables proved more valuable in a low-resource environment, while a limited system can be more broadly applied in smaller programs, at higher costs but with more positives found. The use of such tools to select at-risk populations in HCV screenings can facilitate fast, reliable detection and access of a larger population in a resource-constrained situation or special environment.

References

https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf

ARTIFICIAL INTELLIGENCE OPTIMIZATION OF A SCREENING PROGRAM FOR HEPATITIS C – COMPARATIVE ANALYSIS OF DIFFERENT SYSTEMS

Costin Teodor Streba 1, Carmen-Nicoleta Oancea 1, Mădălin Mamuleanu 1, Irina-Paula Doica 1, ION ROGOVEANU 1, Tudorel Ciurea 1, Dan-Ionut Gheonea 1

1 University of Medicine and Pharmacy of Craiova, Craiova, Romania

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

Prognosis and prediction in liver disease (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Mistakes In Articles

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Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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Introduction

The Lithuanian HCV screening programme started in May 2022. General practitioners (GPs) received special promoting fee for serological HCV antibody testing: 1. For people born between 1945 and 1994 (once in a lifetime) and 2. For people who inject drugs (PWID) or HIV-positive people (annual testing). This initiative is the first in Central and Eastern Europe.

Aims & Methods

The aim of this study was to assess the results of the first 34 months of the programme and the different scenarios for achieving the WHO 2030 targets. GPs invited people to perform a serum blood test for HCV antibodies. Anti-HCV positive patients were referred to a gastroenterologist or infectologist for HCV RNA testing, and if result was positive, direct-acting antiviral (DAA) therapy was prescribed. Information about patients was obtained from the database of the National Health Insurance Fund. The Markov disease progression model elaborated by the CDA Foundation was used to assess HCV elimination progress. The data from the 2022-2023 screening were used as inputs. Three scenarios were developed: the ‘Base’ scenario - return to pre-screening program level in 2023 and 2 scenarios with different extents of treatment.

Results

At the beginning of 2022, about 1.8 million people born in 1945-1994 lived in Lithuania. Between May 5, 2022 and February 28, 2025, from this population 1362472 people (75.7%) were tested for HCV antibodies. Positive test results were found in 1.28% of cases. In the risk group, 8396 PWID and/or HIV+ people were screened, of whom 28.9 % were seropositive. Among anti-HCV+ persons 83.8% was from population and 16.2 % from risk groups. Specialists consulted 58% anti-HCV+ persons and viremia was detected in 53,1 %. Among anti-HCV+ persons from population specialist consulted 63%, but only 29% from risk group (p<0.001). Referral to specialist delay were related with specialist waiting lines, and compliance and motivation problems in risk (PWID and/or HIV+) group. During 34-month (May 2022- February 2025) period 3 times more HCV patients were treated with DAA than during the same period before starting of the program (7577 vs 2470). The Markov disease progression model to assess HCV elimination progress showed the following scenarios: Scenario 1: if the same number of patients are treated as before the screening, the WHO targets will not be reached. Scenario 2: treating 70% of infected patients will meet most but not all WHO targets. Scenario 3: by treating all infected patients by 2030, the WHO target will be met by saving 150 lives and preventing 90 new cases of decompensated cirrhosis and 120 cases of hepatocellular carcinoma.

Conclusion

Our data show that in a European country with a moderate HCV seroprevalence, a population-based screening program is feasible: more than 75% (almost 1.4 million) of the population born between 1945 and 1994 was screened, and the number of patients treated has increased by more than 3 times in the first 34 months of the program (as compared to the same time period prior to the program). However, despite abolishment of restrictions to DAA treatment in the country, special measures to increase motivation and compliance of risk group patients to program logistic are necessary to achieve WHO 2030 targets in Lithuania.

References

Petkevičienė J et al. Hepatitis C screening in Lithuania: first-year results and scenarios for achieving WHO elimination targets. BMC Public Health. 2024; 24(1):105.

POPULATION-BASED HEPATITIS C SCREENING AND ELIMINATION PROGRAM IN LITHUANIA: CURRENT RESULTS AND CHALLENGES

Limas Kupcinskas 1, Gediminas Urbonas 1, Viaceslavas Zaksas 2, Artur Kozlov 2, Jurate Sabaliene 2, Alexis Voeller 3, Devin Razavi-Shearer 3, John Ward 4, Juozas Kupcinskas 1, Janina Petkevicienė 1

1 Lithuanian University of Health Sciences, Kaunas, Lithuania

2 National Health Insurance Fund under the Ministry of Health, Vilnius, Lithuania

3 Center for Disease Analysis Foundation, Lafayette, United States

4 Coalition for Global Hepatitis Elimination, Decatur, United States

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

LIVER (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Hepatitis C virus infection remains an important global burden despite the efficient DAA treatment available at this moment. A major goal was proposed by WHO in 2019 – elimination of HCV infection until 2030. One of the most important problems is the identification of infected persons in this relatively short time. Due to time and cost impact, a global and even a national screening program for all individuals is a method hard to be achieved. A solution is micro-elimination programs, that are focused on a limited area and a target population. These programs can be implemented much easier, and faster and can be ruled at the same time, with experienced teams that already know all the necessary information and fully optimize resources.

Aims & Methods

This study aims to identify and eliminate HCV infection with micro-elimination programs in targeted areas with a population that has a clear indication for screening, due to the socioeconomic and habitual features. The micro-elimination program started with awareness campaigns. After signing an informed consent form, persons over 40 years old completed a screening questionnaire and were given rapid Anti-HCV Test. Statistical analysis was performed based on the regional register created for these programs. All the positive patients were investigated and treated if they were eligible.

Results

Five micro-elimination programs were conducted from September 2020 to July 2022, and 42,976 persons from 6 counties were included in the screening. The prevalence ranged from 0.52 to 1.58 in the screened population, with predominance among the female sex. We also found statistically significant differences in HCV prevalence between urban and rural areas, industrial and residential settings (p<0.05), but none between age and HCV prevalence. The risk questionnaire revealed an increase risk of HCV infection in persons who required blood transfusions, shared use of personal hygene products, had dental interventions or surgery.

Conclusion

Micro-elimination programs represent important steps in HCV chronic hepatitis elimination and can be implemented with success in disadvantaged populations with limited access to medical care and can be a sustainable complementary action when national screening programs are overwhelmed or delayed in the aim of HCV elimination.

Disclosure

This study was supported by AbbVie SRL, Bucharest, Romania

HEPATITIS C MICRO-ELIMINATION PROGRAMS, A GOOD SOLUTION FOR ACHIEVING THE ERADICATION

Carmen Nicoleta Oancea 1, Costin Teodor Streba 1, Victor-Mihai Sacerdotianu 1, Irina-Paula Doica 1, ION ROGOVEANU 1, Tudorel Ciurea 1, Dan Ionuț Gheonea 1

1 University of Medicine and Pharmacy of Craiova, Craiova, Romania

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Lithuanian program for hepatitis C screening started on May, 2022. Based on results of our pilot study conducted in Klaipeda city (1) Lithuanian health authorities decided to pay general practitioners (GPs) a special fee for a service of promoting and performing serological tests for hepatitis C virus (HCV) antibodies: 1) for the population born in 1945-1994 (once per life) and 2) for people who inject drugs (PWID) or are HIV-infected (annual HCV testing). Such an initiative is the first in Central and Eastern Europe. This study aimed to evaluate the first results of the HCV screening program and develop different scenarios to achieve WHO targets to eliminate viral hepatitis C by 2030.

Aims & Methods

Patients were invited to participate in the HCV screening by GPs during the visits. Screening included a serum blood test for the presence of HCV antibodies. Patients who tested positive were referred to a gastroenterologist or infectious disease doctor. HCV RNA testing was used to identify the current infection. If the test result was positive, the doctor prescribed direct-acting antiviral (DAA) therapy. Information about screened and treated patients was obtained from the database of the National Health Insurance Fund. The Markov disease progression model elaborated by the CDA Foundation was used to assess HCV elimination progress in Lithuania. The data from the 2022 screening and previously published data were used as inputs. Three scenarios were developed: the ‘Base’ scenario - return to pre-screening program level in 2023 and 2 scenarios with different extents of treatment.

Results

Results: At the beginning of 2022, about 1.8 million people born in 1945-1994 lived in Lithuania. Between May 5, 2022 and January 31, 2023, population of 547627 people (58.9% women) were tested for HCV antibodies. Positive test results were found in 1.3% people. Seroprevalence of HCV antibodies was higher among men than women, 1.6% and 1.1%, respectively. In the risk group, 5345 PWID and HIV-infected people were screened, of whom 31,7% were seropositive. All seropositive patients were referred to specialists. Viremia was detected in 58 % of patients. In 2022, 1586 patients were treated with DAA. Treatment delay was related to organizational problems (specialist consultation waiting line, formal treatment restrictions, delay in drugs supply), but the number of treated patients during last two months of the program (December 2022- January 31, 2023) increased by 330 % in comparison to the same period of previous year before starting of program. If the number of tested patients remains the same as in the last three months in 2022, HCV antibody testing will be completed in 2023/2024. The Markov disease progression model to assess HCV elimination progress in Lithuania showed the following scenarios: Scenario 1: if the same number of patients are treated as before the screening, the WHO targets will not be reached. Scenario 2: treating 70% of infected patients (13000 in 2023/2024) will meet most but not all WHO targets. Scenario 3: by treating all infected patients by 2030, the WHO target will be met by saving 150 lives and preventing 90 new cases of decompensated cirrhosis and 120 cases of hepatocellular carcinoma.

Conclusion

In the Lithuanian screening program, HCV antibody testing by GPs is active; however, the number of patients treated needs to be increased to reach the WHO targets.

References

1.Ciupkeviciene E, Petkeviciene J, Sumskiene J, Dragunas G, Dabravalskis S, Kreivenaite E, Telksnys T, Urbonas G, Kupcinskas L. Hepatitis C Virus Epidemiology in Lithuania: Situation before Introduction of the National Screening Programme. Viruses. 2022, 30;14(6):1192

LITHUANIAN PROGRAM FOR HEPATITIS C SCREENING: RESULTS OF THE FIRST 9 MONTHS OF THE PROGRAM AND POSSIBLE SCENARIOS FOR ELIMINATION

Limas Kupcinskas 1, Egle Ciupkeviciene 1, Janina Petkevicienė 1, Gediminas Urbonas 1, Ligita Jancoriene 2, Edita Kazenaite 2, Sarah Blach 3, Alexis Voeller 3, Homie Razavi 3, Ivane Gamkrelidze 3

1 Lithuanian University of Health Sciences, Kaunas, Lithuania

2 Vilnius University, Vilnius, Lithuania

3 Center for Disease Analysis Foundation, Lafayette, United States

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, as well as developments in diagnostic procedures and improvements in therapy and prevention. These therapies make it possible to eliminate hepatitis C as a major public health threat, as per the World Health Organization target, although the timeline and feasibility vary from region to region. These European Association for the Study of the Liver recommendations on treatment of hepatitis C describe the optimal management of patients with recently acquired and chronic HCV infections in 2020 and onwards.

EASL recommendations on treatment of hepatitis C: Final update of the series

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary

Citation

Journal of Hepatology, Volume 73, Issue 5, 1170 - 1218

Published

2020

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Introduction

Opportunistic hepatitis C virus (HCV) screening, taking advantage of laboratory analysis requested to patients for another clinical reasons, has shown to increase HCV detection. Here, we present the results for HCV detection from "Sureste sin C" microelimination program, which is run within Hospital Universitario del Sureste sanitary area in Madrid (Spain). This program includes HCV training at hospital level at different services and in primary care, advertisement on informative panels, automation of preoperative protocol and search of lost to follow-up patients.

Aims & Methods

In July 2021, this HCV micro-elimination program began in our sanitary area. This program was supported by Gilead (within Hospitals without C program). A key point was to favor HCV opportunistic screening at different hospital services, both medical surgical (preoperatory) and Emergency departments. Moreover, systematic HCV serology screening (automatization) was included in the surgical preoperative service. The effectiveness of the program was measured in terms of number of HCV-screening requests made between January-October 2019 (prior to the pandemic, first period) and January-October 2022 (second period).

Results

There were 3,709 requests for HCV serology (3,313 individual patients) in the first period, compared with 7,743 (6,902 individual patients) in the second period (109% increase). Divided by services, this increase was mainly due to the surgical services (251% increase), as a result of the automatic inclusion of HCV serology in the preoperative protocols, and in psychiatry (558% increase). In the medical area, the increase in the second period was 42%, being Gastroenterology, Internal Medicine, Pneumology and Oncology the services with greatest increase in requests. Regarding Emergency department, an increase in requests of 101% was observed. In total, 145 Anti-HCV positive patients were detected in the first period (prevalence 4.37%), 48 being viremic (1.44%), compared to 130 patients in the second period (prevalence 1.88%), 29 viremics (0.42%). Regarding only surgical services, there was a very significant increase in the number of positive serology in the second period (8 vs 45, 462% increase, prevalence 1.14%), as well as in the number of viremics (0 vs 5 patients, prevalence 0.12 %).

Conclusion

HCV serology automatization in the surgical preoperative protocol and the awareness and collaboration with other services to support opportunistic HCV screening, is an effective mechanism to achieve the objective of detecting infected patients within a hepatitis C micro-elimination program. Automatization in surgical preoperatory service has demonstrated to increase the detection of occult HCV infected patients.