Pilot postal birth cohort hepatitis C virus screening in UK primary care: HepCAPP study

Background Birth cohort screening has been implemented in some countries to identify the potentially ‘missed population’ of people with undiagnosed chronic hepatitis C virus (HCV) who may not be found through targeted approaches. Aim To determine uptake of HCV antibody testing using an oral swab screening method, the overall yield, whether those testing positive had risk markers in their primary care record, and the cost per case detected. Design and setting This was a pilot screening study set in general practices in the Southwest of England, Yorkshire and Humber, and South London. Method Participants consenting were sent an oral swab kit in the post and saliva samples were tested for antibodies to HCV. Results In total, 16 436/98 396 (16.7%) patients consented and were sent an oral swab kit. Of these, 12 216 (12.4%) returned a kit, with 31 participants (yield 0.03%) testing positive for HCV antibodies. Of those positive, 14/35 (45%) had a risk marker for HCV on their primary care record. Two (yield 0.002%) were confirmed RNA positive and referred for treatment, both had HCV risk markers. The cost per case was £16 000 per HCV antibody detected and £247 997 per chronic HCV detected. Conclusion Wide-scale screening could be delivered and identify people infected with HCV, however, most of these individuals could have been detected through lower-cost targeted screening. The yield and cost per case found in patients were substantially worse than model estimates and targeted screening studies. Birth cohort screening should not be rolled out in primary care in England.