Universal Screening for HIV and Hepatitis C Infection: A Community-Based Pilot Project

Abstract

Introduction Black men in the Deep South have been disproportionally affected by high human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection rates. Conventional clinic-based screening approaches have had limited success in reaching those undiagnosed with HIV or HCV infection. The purpose of this study was to evaluate the acceptability, feasibility and best practices of an integrated HIV and HCV community-based health screening approach. Methods The study used a mixed-methods approach – focus group discussion, individual interviews and surveys - assessing perceptions, perspectives, and HIV and HCV awareness among six communities across Alabama and Mississippi. Data were collected and analyzed in 2014–2017. Results While HIV and HCV knowledge was limited among community members surveyed, the results of this study suggest that a) using an integrated, community-based HIV and HCV testing approach is acceptable and feasible; b) formation of a community advisory board is a key element of successful community mobilization; c) education and training of community members on disease specific topics and overcoming stigma are essential; and d) focus on and inclusion of young community members will be critical for the sustainability of screening efforts. Conclusion Including and engaging communities at risk for HIV and HCV infection in prevention research is a promising strategy to overcome existing barriers of stigma and discrimination. Integration of HIV and HCV testing in universal health screening efforts utilizing a Community Health Advisors model encourages unbiased communication with a focus on overall community health. Community health advisors are recognized as important agents in this effort.

CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020

“…No study compared harms systematically using comparison groups associated with different screening approaches. Harms informed by the alladult review included physical harms of screening (two studies) (48,49); anxiety/stress related to testing or waiting for results (five studies) (49-53); cost (one study) (54); anxiety related to receiving positive results (one study) (55); interpersonal outcomes (e.g., problems related to family, friends from learning HCV infection status) (five studies) (51,(55)(56)(57)(58); attitudes toward persons with hepatitis C, including stigma (11 studies) (49,55,(57)(58)(59)(60)(61)(62)(63)(64)(65); time for screening (two studies) (49,66); and false-positive results, including among left ventricular assist device patients, possibly precluding heart transplantation (six studies) (67)(68)(69)(70)(71)(72). Harms informed by the pregnancy review included physical harms of screening (one study) (73), anxiety (five studies) (74)(75)(76)(77)(78), stigma (one study) (77), psychological issues (two studies) (73,79), fears related to sexual relationships (one study) (80), legal ramifications and potential loss of infant custody (one study) (81), decreased quality of life (one study) (82), social repercussions (one study)…”

Mitochondrial changes associated with viral infectious diseases in the paediatric population

“…2 Importantly, these abnormalities have been correlated with the onset of clinical symptoms in the paediatric population; that is, mitochondrial alterations are more evident in children presenting clinical manifestations (such as lipodystrophy under HAART) than in those who do not. 104 Co‐infection with HIV/HCV is a main issue also in the paediatric population 218 and primary hepatitis is related to mitochondrial dysfunction, specifically OXPHOS and Δψm alterations. 189 , 190 , 191 In many viral infections, mitochondrial abnormalities can also lead to long‐term metabolic complications, 110 emphasizing the importance of longitudinal studies assessing mitochondrial changes and derived clinical consequences over time in the paediatric population.…”

Hepatitis C in Black Individuals in the US

“…The Viral Hepatitis National Strategic Plan recommends strategies to increase HCV awareness in Black and other racial and ethnic minority communities, including developing and disseminating accessible linguistically appropriate HCV education materials that align with cultural beliefs and values . Data suggest that use of community-based participatory methods, including a community advisory board, education and training for community members on HCV topics, and overcoming stigma toward HCV, and involvement of young community members (who volunteer or coach in the community and are better positioned for outreach activities) may help increase knowledge and screening rates among racial and ethnic minority populations …”

“…Community leaders and stakeholders, such as faith-based leaders, peer educators, and medical professionals, may increase access to care in racial and ethnic minority populations by addressing feelings of stigmatization and reducing doubt and apprehension regarding HCV treatment . Other approaches include using health literacy tools and communication campaign materials (eg, fact sheets, pamphlets, posters) depicting individuals from diverse races and ethnicities who describe positive experiences with HCV treatment .…”