Letter: Addressing Gaps in Hospital-Based Hepatitis C Screening—Insights and Recommendations

Abstract

We have carefully reviewed Ferrarese et al.'s study on the effectiveness of hospital-based hepatitis C virus (HCV) screening activities [1]. This research offers crucial data for identifying HCV-infected patients beyond current national screening policies, and provides valuable insights for public health interventions. However, we propose several considerations and recommendations to enhance the study.

Firstly, the study does not sufficiently analyse patients' comorbid conditions. Hospitalised patients often have chronic diseases such as diabetes, metabolic syndrome or cardiovascular diseases, which increase HCV infection risk and influence treatment adherence and outcomes [2, 3]. Stratified analysis by comorbidities could clarify the interplay between HCV infection and overall health, aiding in the development of targeted screening and treatment strategies.

Secondly, the research inadequately addresses patients' socioeconomic status (SES), a key factor affecting healthcare access and screening participation [4, 5]. Individuals with low-income or education levels may encounter greater barriers due to financial constraints or lack of information [6]. Collecting data on income, education and employment, and examining their impact on screening and treatment, would provide a more comprehensive understanding of how socioeconomic disparities impede HCV prevention and control.

Thirdly, while the study notes that 82.5% of hospitalised patients were not screened, it does not examine the specific characteristics of this unscreened group, such as age, gender, comorbidities or departmental distribution. This selection bias may limit the representativeness of the findings. We recommend a retrospective analysis of hospital records to identify traits of the unscreened population, enabling a more accurate assessment of HCV prevalence among hospitalised patients and the creation of more inclusive screening strategies.

Additionally, the study finds that female patients with positive viral loads are significantly older than males, while it does not explore the reasons for this gender disparity. This difference might relate to unique risk factors for disease progression in women or barriers to healthcare access. Future research should investigate this phenomenon to optimise screening and treatment approaches for female patients.

Lastly, the study mentions that some patients were lost to follow-up after referral to local centres but does not suggest specific improvements for follow-up management. Loss to follow-up can severely impact treatment outcomes, particularly for foreign patients or those with limited medical resources. To address these issues comprehensively, we suggest integrating social work practices to enhance HCV screening and treatment effectiveness. Health education and outreach through community lectures and multilingual support can help high-risk groups understand the importance of screening and overcome cultural or language barriers. Providing financial assistance or mobile screening services for low-income or resource-limited populations can reduce participation barriers. For foreign and female patients, culturally adapted educational materials, flexible screening schedules and childcare services can offer targeted support. Additionally, case management models and digital follow-up tools can improve long-term adherence, while establishing patient support groups and advocating for policy enhancements (such as expanding free screening coverage) can create synergistic effects from grassroots to policy levels.

In conclusion, Ferrarese et al. have significantly advanced HCV screening efforts. Addressing the aforementioned issues would enhance the study's credibility and practical applicability, providing more comprehensive scientific support for optimising screening and treatment strategies.

Zhen Deng: methodology, formal analysis, writing – original draft. Lincheng Duan: methodology, writing – original draft. Kai Wang: conceptualization, methodology, supervision, writing – review and editing.

The authors declare no conflicts of interest.

This article is linked to Ferrarese et al papers. To view these articles, visit https://doi.org/10.1111/apt.18433 and https://doi.org/10.1111/apt.18505.