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Rev Esp Enferm Dig. 2020 Mar 18. doi: 10.17235/reed.2020.6370/2019. [Epub ahead of print]

Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia.

Author information

1
Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs, España.
2
Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de I.
3
Servicio de Microbiología, Hospital Universitario de Puerto Real.
4
Servicio de Microbiología, Hospital Costa del Sol.
5
Servicio de Microbiología, Hospital Infanta Elena.
6
Servicio de Microbiología, Hospital Universitario Virgen de la Victoria.
7
Servicio de Microbiología, Hospital Juan Ramón Jiménez.
8
Servicio de Microbiología, Hospital Ciudad de Jaén.
9
Servicio de Microbiología, Hospital San Juan de la Cruz.
10
Servicio de Microbiología, Hospital San Agustín.
11
Servicio de Microbiología, Hospital Río Tinto.
12
Servicio de Microbiología, Hospital de Baza.
13
Servicio de Microbiología, Hospital Santa Ana.
14
Servicio de Microbiología, Hospital Universitario Torrecárdenas.
15
Servicio de Microbiología, Hospital Universitario Virgen de Valme.
16
Servicio de Microbiología, Hospital San Juan de Dios del Aljarafe.
17
Servicio de Microbiología, Hospital Universitario Puerta del Mar.
18
Servicio de Microbiología, Hospital SAS La Línea.
19
Servicio de Microbiología, Hospital Serranía de Ronda.
20
Servicio de Microbiología, Hospital Ciudad de Jaén .
21
Servicio de Microbiología, Hospital la Axarquía.
22
Servicio de Microbiología, Hospital de Poniente.
23
Servicio de Microbiología, Hospital Universitario de Jerez de la Frontera.
24
Servicio de Microbiología, Hospital Universitario Virgen del Rocío.
25
Servicio de Microbiología, Hospital Punta de Europa.
26
Servicio de Microbiología, Hospital La Inmaculada.
27
Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs.

Abstract

BACKGROUND AND AIM:

undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated.

PATIENTS AND METHODS:

an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated.

RESULTS:

the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86).

CONCLUSIONS:

in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.

PMID:
32188257
DOI:
10.17235/reed.2020.6370/2019
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