Novel Implementation of Hepatitis B to Hepatitis Delta Reflex Testing in a US Healthcare System

Area of Science:

• Hepatology
• Infectious Diseases
• Public Health

Background:

• Hepatitis delta virus (HDV) represents the most aggressive form of viral hepatitis.
• Screening rates for HDV in the United States are notably low.
• Interventions to enhance the HDV screening cascade are infrequently implemented.

Purpose of the Study:

• To assess barriers to implementing reflex testing for HDV.
• To implement hepatitis B surface antigen (HBsAg) to HDV antibody (HDV Ab) reflex testing within a large academic healthcare system.
• To evaluate the impact of reflex testing on the HDV screening cascade.

Main Methods:

• Outcomes were evaluated one year post-implementation using summary statistics.
• Multivariable logistic regression analyzed patient and clinic characteristics associated with reflex vs. standalone HBsAg testing.
• The study assessed barriers including the lack of an FDA-approved reflex test.

Main Results:

• All patients with a reflex order and HBsAg-positive result received timely HDV Ab follow-up.
• Time to HDV Ab result was significantly shorter with reflex testing (2 days) compared to separate orders (11 days).
• Reflex order uptake was highest in primary care settings due to workflow integration.

Conclusions:

• Reflex testing enhances efficiency and reduces gaps in the HBsAg to HDV screening cascade.
• Disparities in reflex testing rates among patient groups were identified.
• The findings underscore the necessity for universal implementation of reflex testing.