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Table 3 Adaptation (with permission) of Table 1. Summary of recommendations on testing for chronic hepatitis B and C virus infection, from WHO Guidelines on hepatitis B and C testing [10]). Who to test for chronic HCV infection

From: WHO guidelines on testing for hepatitis B and C – meeting targets for testing

Testing approach and population Recommendationsa
Focused testing in most affected populations 1. In all settings (and regardless of whether delivered through facility- or community- based testing), it is recommended that serological testing for HCV antibody (anti- HCV)b be offered with linkage to prevention, care and treatment services to the following individuals:
 • Adults and adolescents from populations most affected by HCV infectionc (i.e. who are either part of a population with high HCV seroprevalence or who have a history of exposure and/or high-risk behaviours for HCV infection);
 • Adults, adolescents and children with a clinical suspicion of chronic viral hepatitisd(i.e. symptoms, signs, laboratory markers).
Strong recommendation, low quality of evidence
Note: Periodic re-testing using HCV NAT should be considered for those with ongoing risk of acquisition or reinfection.
General population testing 2. In settings with a ≥ 2% or ≥5%e HCV antibody seroprevalence in the general population, it is recommended that all adults have access to and be offered HCV serological testing with linkage to prevention, care and treatment services.
 General population testing approaches should make use of existing community- or facility-based testing opportunities or programmes such as HIV or TB clinics, drug treatment services and antenatal clinicsf.
Conditional recommendation, low quality of evidence
Birth cohort testing 3. This approach may be applied to specific identified birth cohorts of older persons at higher risk of infectiongand morbidity within populations that have an overall lower general prevalence.
Conditional recommendation, low quality of evidence
  1. Abbreviations: NAT nucleic acid test, anti-HCV HCV antibody, PWID people who inject drugs, MSM men who have sex with men
  2. aThe GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) was used to categorize the strength of recommendations as strong or conditional (based on consideration of the quality of evidence, balance of benefits and harms, acceptability, resource use and programmatic feasibility) and the quality of evidence as high, moderate, low or very low
  3. bThis may include fourth-generation combined antibody/antigen assays
  4. cIncludes those who are either part of a population with higher seroprevalence (e.g. some mobile/migrant populations from high/intermediate endemic countries, and certain indigenous populations) or who have a history of exposure or high-risk behaviours for HCV infection (e.g. PWID, people in prisons and other closed settings, MSM and sex workers, and HIV-infected persons, children of mothers with chronic HCV infection especially if HIV-coinfected)
  5. dFeatures that may indicate underlying chronic HCV infection include clinical evidence of existing liver disease, such as cirrhosis or hepatocellular carcinoma (HCC), or where there is unexplained liver disease, including abnormal liver function tests or liver ultrasound
  6. eA threshold of ≥2% or ≥5% seroprevalence was based on several published thresholds of intermediate and high seroprevalence. The threshold used will depend on other country considerations and epidemiological context
  7. fRoutine testing of pregnant women for HCV infection is currently not recommended
  8. gBecause of historical exposure to unscreened or inadequately screened blood products and/or poor injection safety