Journal Article > ResearchFull Text
BMC Infect Dis. 2021 February 26; Volume 21 (Issue 1); 223.; DOI:10.1186/s12879-021-05826-0
Lynch E, Falq G, Sun C, Bunchhoeung PDT, Huerga H, et al.
BMC Infect Dis. 2021 February 26; Volume 21 (Issue 1); 223.; DOI:10.1186/s12879-021-05826-0
BACKGROUND
Despite a dramatic reduction in HCV drug costs and simplified models of care, many countries lack important information on prevalence and risk factors to structure effective HCV services.
METHODS
A cross-sectional, multi-stage cluster survey of HCV seroprevalence in adults 18 years and above was conducted, with an oversampling of those 45 years and above. One hundred forty-seven clusters of 25 households were randomly selected in two sets (set 1=24 clusters =18; set 2=123 clusters, =45). A multi-variable analysis assessed risk factors for sero-positivity among participants =45. The study occurred in rural Moung Ruessei Health Operational District, Battambang Province, Western Cambodia.
RESULTS
A total of 5098 individuals and 3616 households participated in the survey. The overall seroprevalence was 2.6% (CI95% 2.3-3.0) for those =18 years, 5.1% (CI95% 4.6-5.7) for adults = 45 years, and 0.6% (CI95% 0.3-0.9) for adults 18-44. Viraemic prevalence was 1.9% (CI95% 1.6-2.1), 3.6% (CI95% 3.2-4.0), and 0.5% (CI95% 0.2-0.8), respectively. Men had higher prevalence than women: =18 years male seroprevalence was 3.0 (CI95% 2.5-3.5) versus 2.3 (CI95% 1.9-2.7) for women. Knowledge of HCV was poor: 64.7% of all respondents and 57.0% of seropositive participants reported never having heard of HCV. Risk factor characteristics for the population =45 years included: advancing age (p< 0.001), low education (higher than secondary school OR 0.7 [95% CI 0.6-0.8]), any dental or gum treatment (OR 1.6 [95% CI 1.3-1.8]), historical routine medical care (medical injection after 1990 OR 0.7 [95% CI 0.6-0.9]; surgery after 1990 OR 0.7 [95% CI0.5-0.9]), and historical blood donation or transfusion (blood donation after 1980 OR 0.4 [95% CI 0.2-0.8]); blood transfusion after 1990 OR 0.7 [95% CI 0.4-1.1]).
CONCLUSIONS
This study provides the first large-scale general adult population prevalence data on HCV infection in Cambodia. The results confirm the link between high prevalence and age =45 years, lower socio-economic status and past routine medical interventions (particularly those received before 1990 and 1980). This survey suggests high HCV prevalence in certain populations in Cambodia and can be used to guide national and local HCV policy discussion.
Despite a dramatic reduction in HCV drug costs and simplified models of care, many countries lack important information on prevalence and risk factors to structure effective HCV services.
METHODS
A cross-sectional, multi-stage cluster survey of HCV seroprevalence in adults 18 years and above was conducted, with an oversampling of those 45 years and above. One hundred forty-seven clusters of 25 households were randomly selected in two sets (set 1=24 clusters =18; set 2=123 clusters, =45). A multi-variable analysis assessed risk factors for sero-positivity among participants =45. The study occurred in rural Moung Ruessei Health Operational District, Battambang Province, Western Cambodia.
RESULTS
A total of 5098 individuals and 3616 households participated in the survey. The overall seroprevalence was 2.6% (CI95% 2.3-3.0) for those =18 years, 5.1% (CI95% 4.6-5.7) for adults = 45 years, and 0.6% (CI95% 0.3-0.9) for adults 18-44. Viraemic prevalence was 1.9% (CI95% 1.6-2.1), 3.6% (CI95% 3.2-4.0), and 0.5% (CI95% 0.2-0.8), respectively. Men had higher prevalence than women: =18 years male seroprevalence was 3.0 (CI95% 2.5-3.5) versus 2.3 (CI95% 1.9-2.7) for women. Knowledge of HCV was poor: 64.7% of all respondents and 57.0% of seropositive participants reported never having heard of HCV. Risk factor characteristics for the population =45 years included: advancing age (p< 0.001), low education (higher than secondary school OR 0.7 [95% CI 0.6-0.8]), any dental or gum treatment (OR 1.6 [95% CI 1.3-1.8]), historical routine medical care (medical injection after 1990 OR 0.7 [95% CI 0.6-0.9]; surgery after 1990 OR 0.7 [95% CI0.5-0.9]), and historical blood donation or transfusion (blood donation after 1980 OR 0.4 [95% CI 0.2-0.8]); blood transfusion after 1990 OR 0.7 [95% CI 0.4-1.1]).
CONCLUSIONS
This study provides the first large-scale general adult population prevalence data on HCV infection in Cambodia. The results confirm the link between high prevalence and age =45 years, lower socio-economic status and past routine medical interventions (particularly those received before 1990 and 1980). This survey suggests high HCV prevalence in certain populations in Cambodia and can be used to guide national and local HCV policy discussion.
Conference Material > Abstract
Sun C
Epicentre Scientific Day Paris 2019. 2019 June 13
This study of HCV prevalence in adults in Cambodia shows higher seropositivity with older age, poverty, lower education levels, and past routine medical interventions.
BACKGROUND
Despite a dramatic reduction of HCV drug costs and proven, simplified models of care, many countries lack accurate prevalence estimates to scale up HCV services.
METHODS
We conducted a cross-sectional, multi-stage cluster design survey of HCV sero-prevalence in adults ≥18 years old, with an oversampling of the population ≥45 years. 147 clusters of 25 households were randomly selected in two sets (set 1=24 clusters, ≥18-year-old respondents; set 2=123 clusters, exclusively ≥45-year-old respondents). A multivariate analysis assessed risk factors for sero positivity among participants aged ≥45. The study was conducted in rural Moung Ruessei Health Operational District, Battambang Province, in Western Cambodia.
RESULTS
A total of 5 103 individuals and 3 616 households participated in the survey. The overall seroprevalence for the entire adult population aged ≥18 years was 2.61% (CI95% 2.25-2.96), with 5.10% (CI95% 4.55-5.65) for adults aged ≥45, and 0.58% (CI95% 0.27-0.89) for adults 18-44. Viraemic prevalence for these same populations was 1.87% (CI95% 1.62-2.14), 3.62% (CI95% 3.22-4.01), and 0.47% (CI95% 0.17 - 0.76), respectively. Men were more likely to be positive both serologically and by viral load; considering the population aged ≥18, the serological prevalence for men was 3.03 (CI95% 2.54 - 3.52), and 2.27 (CI95% 1.87 - 2.66) for women. Risk factors identified for the population ≥45 years included: more advanced age, lower education level, membership in an ID poor card program, injection for medical use or surgery before 1990, blood donation or transfusion before 1980 and having ever had dental or gum treatment.
CONCLUSIONS
This study provides the first large-scale prevalence data on HCV infection in the general adult population of three rural districts of Cambodia and clarifies several important infection trends: for adults ≥45 years, sero-positivity was more likely with increased age, poverty, a low level of education, and past routine medical interventions (especially prior to 1990 and 1980).
BACKGROUND
Despite a dramatic reduction of HCV drug costs and proven, simplified models of care, many countries lack accurate prevalence estimates to scale up HCV services.
METHODS
We conducted a cross-sectional, multi-stage cluster design survey of HCV sero-prevalence in adults ≥18 years old, with an oversampling of the population ≥45 years. 147 clusters of 25 households were randomly selected in two sets (set 1=24 clusters, ≥18-year-old respondents; set 2=123 clusters, exclusively ≥45-year-old respondents). A multivariate analysis assessed risk factors for sero positivity among participants aged ≥45. The study was conducted in rural Moung Ruessei Health Operational District, Battambang Province, in Western Cambodia.
RESULTS
A total of 5 103 individuals and 3 616 households participated in the survey. The overall seroprevalence for the entire adult population aged ≥18 years was 2.61% (CI95% 2.25-2.96), with 5.10% (CI95% 4.55-5.65) for adults aged ≥45, and 0.58% (CI95% 0.27-0.89) for adults 18-44. Viraemic prevalence for these same populations was 1.87% (CI95% 1.62-2.14), 3.62% (CI95% 3.22-4.01), and 0.47% (CI95% 0.17 - 0.76), respectively. Men were more likely to be positive both serologically and by viral load; considering the population aged ≥18, the serological prevalence for men was 3.03 (CI95% 2.54 - 3.52), and 2.27 (CI95% 1.87 - 2.66) for women. Risk factors identified for the population ≥45 years included: more advanced age, lower education level, membership in an ID poor card program, injection for medical use or surgery before 1990, blood donation or transfusion before 1980 and having ever had dental or gum treatment.
CONCLUSIONS
This study provides the first large-scale prevalence data on HCV infection in the general adult population of three rural districts of Cambodia and clarifies several important infection trends: for adults ≥45 years, sero-positivity was more likely with increased age, poverty, a low level of education, and past routine medical interventions (especially prior to 1990 and 1980).
Journal Article > ResearchFull Text
J Clin Virol. 2019 February 1; Volume 111; 39-41.; DOI:10.1016/j.jcv.2018.12.008
Sun C, Iwamoto M, Calzia A, Sreng B, Yann S, et al.
J Clin Virol. 2019 February 1; Volume 111; 39-41.; DOI:10.1016/j.jcv.2018.12.008
BACKGROUND
Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030.
OBJECTIVES
The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD Bioline© HCV, a low-cost rapid diagnostic test (RDT), prequalified by WHO in 2016 on venous blood samples.
STUDY DESIGN
Recruitment was conducted prospectively among adult patients presenting for HCV testing at the Médecins Sans Frontières (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD Bioline© HCV. Two independent, blinded readers, and in the case of disagreement, a third reader, interpreted the results of each blood sample. Concordance between results was compared using Cohen's Kappa interrater reliability statistic. Discrepant sample pairs were tested with an enzyme immunoassay, the reference standard, at the Institute Pasteur of Cambodia.
RESULTS
Among 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA.
CONCLUSIONS
Capillary and venous blood samples were concordant when tested with HCV SD Bioline© in a clinical context. This simplified testing approach is essential to the scale-up of HCV screening and useful in resource-limited settings or among populations for whom venipuncture is problematic.
Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030.
OBJECTIVES
The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD Bioline© HCV, a low-cost rapid diagnostic test (RDT), prequalified by WHO in 2016 on venous blood samples.
STUDY DESIGN
Recruitment was conducted prospectively among adult patients presenting for HCV testing at the Médecins Sans Frontières (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD Bioline© HCV. Two independent, blinded readers, and in the case of disagreement, a third reader, interpreted the results of each blood sample. Concordance between results was compared using Cohen's Kappa interrater reliability statistic. Discrepant sample pairs were tested with an enzyme immunoassay, the reference standard, at the Institute Pasteur of Cambodia.
RESULTS
Among 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA.
CONCLUSIONS
Capillary and venous blood samples were concordant when tested with HCV SD Bioline© in a clinical context. This simplified testing approach is essential to the scale-up of HCV screening and useful in resource-limited settings or among populations for whom venipuncture is problematic.
Conference Material > Video
Sun C
Epicentre Scientific Day Paris 2019. 2019 June 13
Journal Article > ResearchFull Text
J Clin Virol. 2019 September 1; Volume 111; 39-41.; DOI:10.1016/j.jcv.2018.12.008
Sun C, Iwamoto M, Calzia A, Sreng B, Yann S, et al.
J Clin Virol. 2019 September 1; Volume 111; 39-41.; DOI:10.1016/j.jcv.2018.12.008
BACKGROUND
Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030.
OBJECTIVES
The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD Bioline© HCV, a low-cost rapid diagnostic test (RDT), prequalified by WHO in 2016 on venous blood samples.
STUDY DESIGN
Recruitment was conducted prospectively among adult patients presenting for HCV testing at the Médecins Sans Frontières (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD Bioline© HCV. Two independent, blinded readers, and in the case of disagreement, a third reader, interpreted the results of each blood sample. Concordance between results was compared using Cohen's Kappa interrater reliability statistic. Discrepant sample pairs were tested with an enzyme immunoassay, the reference standard, at the Institute Pasteur of Cambodia.
RESULTS
Among 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA.
CONCLUSIONS
Capillary and venous blood samples were concordant when tested with HCV SD Bioline© in a clinical context. This simplified testing approach is essential to the scale-up of HCV screening and useful in resource-limited settings or among populations for whom venipuncture is problematic.
Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030.
OBJECTIVES
The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD Bioline© HCV, a low-cost rapid diagnostic test (RDT), prequalified by WHO in 2016 on venous blood samples.
STUDY DESIGN
Recruitment was conducted prospectively among adult patients presenting for HCV testing at the Médecins Sans Frontières (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD Bioline© HCV. Two independent, blinded readers, and in the case of disagreement, a third reader, interpreted the results of each blood sample. Concordance between results was compared using Cohen's Kappa interrater reliability statistic. Discrepant sample pairs were tested with an enzyme immunoassay, the reference standard, at the Institute Pasteur of Cambodia.
RESULTS
Among 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA.
CONCLUSIONS
Capillary and venous blood samples were concordant when tested with HCV SD Bioline© in a clinical context. This simplified testing approach is essential to the scale-up of HCV screening and useful in resource-limited settings or among populations for whom venipuncture is problematic.
Journal Article > ResearchFull Text
J Viral Hepat. 2018 December 3; Volume 26 (Issue 1); 38-47.; DOI:10.1111/jvh.13002
Iwamoto M, Calzia A, Dublineau A, Rouet F, Nouhin J, et al.
J Viral Hepat. 2018 December 3; Volume 26 (Issue 1); 38-47.; DOI:10.1111/jvh.13002
GeneXpert® (Cepheid) is the only WHO prequalified platform for hepatitis C virus (HCV) nucleic acid amplification testing that is suitable for point-of-care use in resource-limited contexts. However, its application is constrained by the lack of evidence on genotype 6 (GT6) HCV. We evaluated its field performance among a patient population in Cambodia predominantly infected with GT6. Between August and September 2017, we tested plasma samples obtained from consenting patients at Médecins Sans Frontières' HCV clinic at Preah Kossamak Hospital for HCV viral load (VL) using GeneXpert® and compared its results to those obtained using COBAS® AmpliPrep/Cobas® TaqMan® HCV Quantitative Test, v2.0 (Roche) at the Institut Pasteur du Cambodge. Among 769 patients, 77% of the seropositive patients (n = 454/590) had detectable and quantifiable VL using Roche and 43% (n = 195/454) were GT6. The sensitivity and specificity of GeneXpert® against Roche were 100% (95% CI 99.2, 100.0) and 98.5% (95% CI 94.8, 99.8). The mean VL difference was -0.01 (95% CI -0.05, 0.02) log10 IU/mL for 454 samples quantifiable on Roche and -0.07 (95% CI -0.12, -0.02) log10 IU/mL for GT6 (n = 195). The limit of agreement (LOA) was -0.76 to 0.73 log10 IU/mL for all GTs and -0.76 to 0.62 log10 IU/mL for GT6. Twenty-nine GeneXpert® results were outside the LOA. Frequency of error and the median turnaround time (TAT) for GeneXpert® were 1% and 0 days (4 days using Roche). We demonstrated that the GeneXpert® HCV assay has good sensitivity, specificity, quantitative agreement, and TAT in a real-world, resource-limited clinical setting among GT6 HCV patients.