People with serious mental illness ‘priority group’ for HCV screening
Individuals with serious mental illness had high hepatitis C virus prevalence, according to results of a systematic review and meta-analysis published in Journal of Clinical Psychiatry.
“People with [serious mental illness] have a preponderance of HCV risk factors, including a 16% to 22% estimated lifetime prevalence of injecting drug use, as well as heightened incarceration rates relative to non-[serious mental illness] populations,” Michael Rudi Braude, MSc, MBBS, of the department of gastroenterology and hepatology at Monash Health in Australia, and colleagues wrote. “While these risk factors may tend to overlap with other key, decentralized HCV elimination strategies, such as through [opioid substitution therapy] and prison programs, [serious mental illness] populations as a whole require focused strategic engagement.”
The investigators conducted a meta-analysis of HCV prevalence among individuals with serious mental illness, as well as a systematic review of barriers to care. They hypothesized that individual complications and HCV community transmission may be addressed via enhanced health care strategies. They searched five databases between April 21, 1989, and July 1, 2020, for articles published in English. They cross-referenced the terms “Hepatitis C Virus,” “HCV,” “HCV seroprevalence” and “HCV prevalence” with “serious mental illness,” “severe mental illness,” “psychiatric illness,” “mental illness” and “psychiatric patients.”
In the final analysis, Braude and colleagues included 36 publications drawn from prospective and large retrospective studies with cross-sectional screening for HCV among individuals with serious mental illness who were aged 18 years or older.
Results showed a pooled HCV prevalence of 8% (95% CI, 6%-9%). Sub-analysis of prospective studies that featured a total of 9,015 individuals showed a comparable prevalence (8%; 95% CI, 5%-11%) to that of retrospective studies that featured a total of 289,246 individuals (8%; 6%-10%). Those with serious mental illness had HCV prevalence three times to 11.3 times higher than controls.
Results of semiqualitative analysis of seropositive cases demonstrated 20% to 58.1% did not have an identified HCV risk factor, 12.5% to 100% of cases were not previously reported to have HCV and 57% to 96.6% of those with serious mental illness were receptive to HCV screening.
“A first step is to recognize [serious mental illness] as a priority group for HCV screening and to adopt broad population screening with an emphasis on a patient-centered approach,” Braude and colleagues wrote. “This is acknowledging that BBV screening has high acceptability among individuals with [serious mental illness] and that cross-sectional screening is effective in identifying previously undiagnosed HCV. In terms of bridging existing barriers, innovative models of care that maximize opportunity for destigmatized screening and minimize complexity of follow-up will likely translate to an improved cascade of care and enhanced health outcomes.”