Targeted Screening for Viral Hepatitis Among Various Ethnic Groups in Amsterdam, the Netherlands

Background: A significant portion of individuals with hepatitis B virus (HBV) or hepatitis C virus (HCV) in the Netherlands remain undiagnosed, with a majority from migrant backgrounds. Objectives: This study explored whether targeting HBV/HCV screening among individuals with metabolic risk factors enhances screening efficacy within a diverse ethnic cohort. Methods: Participants from six ethnic backgrounds were enlisted from the population-based, prospective HELIUS study in the Netherlands. Included were participants at elevated risk for non-alcoholic fatty liver disease (NAFLD), identified by elevated non-invasive tests (NITs) and/or metabolic risk factors, who were then tested for HBV/HCV. We evaluated screening efficiency, defined as the prevalence of HBV/HCV, by implementing two targeted screening strategies: (1) Testing individuals with elevated NITs; and (2) those with metabolic risk factors. These strategies were compared to a generic testing approach previously utilized in a subset of HELIUS participants. For non-Dutch origin participants, analyses were stratified based on the HBsAg-prevalence in their region of origin: Low (< 2%) and intermediate (2 - 8%). Results: The study included 346 participants at risk for NAFLD, predominantly of Surinamese (n = 180; 45%), Dutch (n = 103; 26%), or Ghanaian (n = 63; 16%) origin. The generic testing approach encompassed 3,050 individuals. Among individuals from low and intermediate HBV-endemic countries, HBsAg-prevalence was 4.7% and 5.3% for those with elevated NITs, 3.9%, and 3.5% for those with metabolic risk factors, and 0.8% and 3.7% for generic testing, respectively. Regarding HCV, two individuals were anti-HCV-positive, with none being HCV-RNA-positive. Conclusions: Targeted screening based on metabolic risk factors or elevated NITs may be more efficient than generic screening among migrants from regions with low HBV prevalence.