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Generalized implementation of reflex testing of hepatitis C in Galicia: Results for reflection
Aldara Vallejo1, Luz María Moldes2, Matilde Trigo3
1Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain.
Insights
Hepatitis C virus (HCV) reflex testing significantly reduced the number of patients not referred for treatment. This strategy identified 258 new cases in 2018, with 81% referred for evaluation, demonstrating improved patient management.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) infection remains a significant public health concern.
- Timely diagnosis and referral for treatment are crucial for effective HCV management.
- Previous strategies had limitations in referring patients for therapeutic evaluation.
Purpose of the Study:
- To evaluate the effectiveness of implementing reflex testing for active HCV infection.
- To assess the impact of informative alerts on patient referral rates for HCV treatment.
- To characterize newly diagnosed active HCV infections identified through reflex testing.
Main Methods:
- Implementation of DUSP (Diagnostic Unit for Sexually Transmitted Infections) in Microbiology Services.
- Retrospective identification and characterization of active HCV infections from 2018 onwards.
- Analysis of referral rates, time to referral, and treatment outcomes for diagnosed patients.
Main Results:
- 258 patients with unknown active HCV infection identified in 2018 via reflex testing.
- 81% of identified patients were referred for therapeutic evaluation.
- High sustained viral response (93.7%) observed in treated patients.
Conclusions:
- Generalized implementation of HCV reflex testing and alerts significantly improves referral rates for treatment.
- Observed referral rates are comparable to other national and international studies.
- Variability between centers highlights the need for further optimization, including training and rescue measures.
Introduction:
The implementation of reflex testing of active hepatitis C virus (HCV) infection, together with the incorporation of informative alerts in the reports, has shown that it significantly reduces the number of patients who were not referred for therapeutic evaluation.
Methods:
Since the implementation in 2018 of the DUSP in the Microbiology Services of the Galician Health Service hospitals (SERGAS), new diagnoses of active HCV infection have been retrospectively identified and characterized.
Results:
In 2018, a total of 258 patients with unknown active HCV infection (70,2% men, middle age 52 years) were identified through by reflex testing from consultations of primary and specialized care units in 54.8% and 39.8% respectively, as well as from other locations by 5.4%. Of the 258 patients, 81.0% were referred for therapeutic evaluation, with a median of 54 days from their diagnosis. In 58.3% of the cases the reflex testing was determined by viral load, the predominant genotype was 1a (30,7%) and 52,1% were treated, observing sustained viral response (SVR) in 93.7 % of these.
Conclusion:
The generalized implementation of the HCV reflex testing together with informative alerts in Galicia has allowed us to obtain referral rates for treatment similar to those obtained in other studies. However, there is a wide variability between the different centers that require the incorporation of improvements, such as training or the use of rescue measures for optimization.
