Answering the call: real world results of viral hepatitis seroprevalence, screening and elimination strategies in Belgium

Subtitle:real world results of viral hepatitis seroprevalence, screening and elimination strategies in Belgium

Abstract:The aim of this thesis is to describe methods that investigate the burden of disease of chronic viral hepatitis B, C and E, and to present efforts to eliminating them. After three introductory chapters, the following chapters describe these projects. The fourth chapter describes screening for chronic HBV infection in migrants, and how to optimise linkage to care. First, this was evaluated in the Asian communities in Antwerp, Leuven and Brussels. Between 10/2014 and 5/2018, 571 persons were tested, and an HBsAg positivity of 6.8% was found. PoC testing showed a higher proportion of people linked to care (86% vs 34%) with a lower cost per person screened (€12.7 vs €54.0). Subsequently, the use of HBV PoC testing was expanded to include African and Middle Eastern populations. Between 11/2017 and 9/2022, dedicated personnel screened 677 people at mandatory civic integration programmes in Antwerp, Belgium. An HBsAg positivity of 3.4% was observed, and all the positively screened persons were linked to care, despite an increase in time-to-follow-up during the COVID-19 pandemic (82 days versus 24 days). The fifth chapter describes a mathematical modelling approach to determine how far along Belgium is in eliminating hepatitis C. Using a Markov disease progression model for HCV and Belgian-specific published and unpublished epidemiologic data, firstly, it was estimated that 18,800 people in Belgium were HCV-RNA positive in 2015. Second, the model estimates that 1,200 individuals need to be treated yearly, to reach the HCV elimination goal. The sixth chapter describes age-specific epidemiology of Hepatitis E virus infection in Belgium. The study was designed to investigate differences in HEV IgG seroprevalence between different age cohorts (serum banks from 2006 and 2014, containing 1579 and 2087 samples). No significant differences in HEV IgG seroprevalence between the age cohorts was found, nor in sex distribution. Modelling showed that age and the province from where the individual originated, were relevant factors. HEV IgG seroprevalences were 4.1% (64/1579, 95% CI 3.1-5.1) and 5.8% (121/2087, CI 4.8-6.9) in 2006 and 2014 respectively. This chapter provides a part of the base evaluation of the burden of disease of hepatitis E virus in Belgium, but continued monitoring thereof is required. Finally, the seventh chapter describes viral hepatitis biobanking. Details are provided in terms of the regulatory, financial and logistical operations required to build and maintain these operations, and the various steps and methodological results in the Antwerp Biobank are described.

Publication year:2025

Keywords:Human medicine

Accessibility:Open