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Hepatitis C reflex testing in Spain in 2019: A story of success
Javier Crespo1, Pablo Lázaro2, Antonio Javier Blasco2
1Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander. IDIVAL, Facultad de Medicina, Universidad de Cantabria, Santander, España.
Insights
Reflex testing for hepatitis C elimination significantly increased in Spanish hospitals to 89% by 2019. However, access to rapid diagnostic and dried blood spot testing remains insufficient, requiring further initiatives.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Reflex testing is crucial for hepatitis C elimination goals.
- In 2017, only 31% of Spanish hospitals utilized reflex testing.
- Scientific societies recommended reflex testing to improve diagnosis and treatment.
Purpose of the Study:
- To assess the 2019 implementation of reflex testing in Spanish hospitals.
- To evaluate the adoption of rapid diagnostic testing (RDT) and/or dried blood spot testing (DBS).
Main Methods:
- A cross-sectional survey was conducted in October 2019.
- The study included Spanish general hospitals with at least 200 beds.
- 129 hospitals (80% response rate) participated.
Main Results:
- Reflex testing implementation rose to 89% in 2019, a significant increase from 31% in 2017.
- The use of alerts for care continuity improved from 69% to 86% between 2017 and 2019.
- Access to RDT and/or DBS methods was limited, with only 43% of hospitals having at least one such method.
Conclusions:
- Significant progress in reflex testing implementation was observed, likely influenced by scientific society recommendations.
- Current access to RDT and/or DBS is inadequate.
- Initiatives are needed to enhance the implementation of rapid diagnostic and dried blood spot testing.
Background:
Reflex testing is necessary to achieve the objectives of hepatitis C elimination. However, in 2017 only 31% of Spanish hospitals performed reflex test. As a consequence of that finding, reflex testing was recommended by scientific societies involved in the diagnosis and treatment of hepatitis C.
Objective:
To evaluate the degree of implementation of reflex testing in 2019 and to know the implementation of rapid diagnostic and/or dried blood spot testing (RDT and / or DBS) in Spanish hospitals.
Methods:
Cross-sectional study through a survey conducted in October 2019 to Spanish general hospitals with at least 200 beds, public or private with teaching accreditation.
Results:
129 (80%) hospitals responded. Reflex testing is performed by 89% of the centers vs. 31% in 2017 (P<.001). From 2017 to 2019, centers using alerts to improve continuity of care increased from 69% to 86% (P=.002). In 2019, 11% of centers can determine anti-HCV in dried spot, 15% viremia in dried spot, 0.85% anti-HCV in saliva, and 37% of antibodies and/or viremia with point of care test. 43% of hospitals have at least one diagnostic method with RDT and/or DBS.
Conclusion:
The implementation of reflex testing has increased significantly, reaching 89% of hospitals in 2019. The recommendations of scientific societies could have contributed to the implementation of reflex testing. On the other hand, access to RDT and/or DBS is insufficient and initiatives are needed to improve their implementation.
