Hepatitis C reflex testing in Spain in 2019: A story of success

Abstract

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.

Keywords: Diagnostic tests; Diagnóstico en un solo paso; Hepatitis C; Reflex testing; Test diagnósticos.