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L'application d'algorithmes de décision et l'utilisation de tests rapides permettent-elles d'optimiser le dépistage et la prévention de l'hépatite B ?

Abstract : In France, more than half of those infected with HBV are unaware of their status. The Optiscreen B program aimed to evaluate the interest of testing recommendations and rapid tests (RT) and in optimizing screening, linkage-to-care, and prevention of hepatitis B. The main results were : Identification of missed opportunities for screening, mainly caused by underestimating country of birth as an important risk factor. Implementing screening recommendations from the CDC could significantly reduce the proportion of infected individuals unaware of their status, but with the disadvantage of many tests. 16% of persons testing HBsAg-positive after screening have an indication for antiviral treatment. 100% with isolated anti-HBcAb had undetectable HBV viral load. HBsAg RTs have sensitivities between 90.5 and 96.5% and specificities greater than 99%. The anti-HBsAb QuickProfileTM has very good specificity (97.8%) but low sensitivity (58.3%). The effectiveness of HBV RT in improving linkage-to-care was not established among persons eligible for HBV-screening. This was due in part to low infection prevalence and insufficient sensitivity of the anti-HBsAb RT. Nevertheless, combined use of HBsAg, HIV, and HCV RT seems to greatly improve the cascade of care among migrants in socially precarious situations and at high-risk of infection. HBV-vaccination after HBV screening does not occur often, mainly because of insufficient physician-patient motivation. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level. Following this work, cost-benefit analysis of different screening strategies is greatly needed.
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Submitted on : Tuesday, November 18, 2014 - 2:59:08 PM
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Julie Bottero. L'application d'algorithmes de décision et l'utilisation de tests rapides permettent-elles d'optimiser le dépistage et la prévention de l'hépatite B ?. Santé publique et épidémiologie. Université Pierre et Marie Curie - Paris VI, 2014. Français. ⟨NNT : 2014PA066213⟩. ⟨tel-01084093⟩

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