الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Infection with the hepatitis C virus is a major global health issue. Although it is preventable, yet infection can lead to chronicity which often progress to cirrhosis and HCC. Egypt had the greatest HCV prevalence in the world, making it the country’s most difficult public health issue.
HCV control depends mainly on treatment, primary prevention and early diagnosis through planned screening strategy that could be applied on the general population as well as high risk groups.
The primary goal of this study was to test for HCV infection in Egypt’s high-risk population (pregnant women) and to validate a developed short risk assessment screening tool among them.
A cross-sectional study was undertaken over the course of three months, among 600 female pregnant women attending antenatal care units in Damanhur city, Beheira governorate.
Participants were asked to complete the risk assessment questionnaire form (EGCRISC). All participants were screened by ELISA for HCV-Ab and further quantitative PCR tested only to positive cases.
The following results were obtained:
HCV was prevalent among 4.2% of pregnant women with 64% viremia.
The mean age of anti-HCV positive women was (31.96±6.201) years.
Among women in the age group 36-44 years old, 6.1% were anti-HCV positive compared to 3% and 3.8% among women in the age group 16 - <26 and 26- <36 respectively.
HCV infection was significantly associated with rural residence (p=0.002) as 5.2% were from rural residence compared to 0.7% from urban areas.
History of fatigue of unexplained reason in the last six months was the only significant factor related to medical history, representing 7.8% of all participants (p=0.00).
Exposure to syringe or sharp instrument contaminated with blood and delivery at home were the most significant factors associated with anti-HCV seropositivity 10.4% and 10.2% of female participants who had past history of exposure to syringe or sharp instrument contaminated with blood and delivery at home were anti-HCV positive, compared to only 3.4% and 3.5% among those who had no such histories respectively.
Independent risk factors associated with anti-HCV seropositivity were living in a rural area (OR=8.41) and fatigue of unexplained reason during the last 6 months (OR=12.58).
Validation of EGCRISC
The EGCRISC has sensitivity of 24% and specificity of 84.35% and a recorded AUC of 0.66; (p=0.01), NPV was 96.23% and PPV was 6%, NLR and PLR were 0.9 and 1.5 respectively among pregnant women > 45 years old.
The average cost per case for EGCRISC tool is less than 1 L.E., while the total cost of ELISA per case is about 90 L.E. The cost- effectiveness ratio for EGCRISC score was 0.002 LE per extra rolled out female compared to 0.158 LE for ELISA which means it costs 3 LE to correctly roll out HCV negative serological status using EGCRISC score compared to 158 LE for ELISA.
6.2. Conclusion
EGCRISC is a valid tool that can be applied on pregnant women attending antenatal care units. Despite of the relatively low HCV prevalence among pregnant women, it is alarming and this group presents a potential hidden source for HCV transmission in the community. Rural residence, history of fatigue of unexplained reason in the last 6 months, exposure to syringe or sharp instrument contaminated with blood and delivery at home were the most important risk factors associated with HCV acquisition in the present study. The use of EGCRISC cut off can be used when high specificity is needed and the zones classification might be applied when high sensitivity is targeted.
6.3. Recommendations
1. Routine risk-based HCV antenatal screening is recommended for pregnant women as a vulnerable group in the community.
2. Application of EGCRISC for pregnant women during their antenatal screening is highly recommended particularly for those living in rural areas and those > 36 years old.