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

• María de la Paz Casas ^[1] ; Fernando García ^[1] ; Carolina Freyre-Carrillo ^[2] ; Natalia Montiel ^[3] ; Alberto de la Iglesia ^[4] ; Isabel Viciana ^[5] ; Ana Domínguez ^[6] ; Vicente Guillot ^[7] ; Aurora Muñoz ^[8] ; Purificación Cantudo ^[9]
  1. [1] Hospital Universitario San Cecilio

     Hospital Universitario San Cecilio

     Granada, España

     
  2. [2] Hospital Universitario de Puerto Real

     Hospital Universitario de Puerto Real

     Puerto Real, España

     
  3. [3] Hospital Costa Del Sol

     Hospital Costa Del Sol

     Marbella, España

     
  4. [4] Hospital Infanta Elena

     Hospital Infanta Elena

     Huelva, España

     
  5. [5] Hospital Universitario Virgen de la Victoria

     Hospital Universitario Virgen de la Victoria

     Málaga, España

     
  6. [6] Hospital Juan Ramón Jiménez

     Hospital Juan Ramón Jiménez

     Huelva, España

     
  7. [7] Hospital Universitario de Jaén

     Hospital Universitario de Jaén

     Jaén, España

     
  8. [8] Hospital San Juan de la Cruz

     Hospital San Juan de la Cruz

     Úbeda, España

     
  9. [9] Hospital San Agustín. Linares, Jaén. Spain

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• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 112, Nº. 7, 2020, págs. 515-519
• Idioma: inglés
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• Resumen

  • 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.