Year 2020 / Volume 112 / Number 7
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Year 2020 / Volume 112 / Number 7


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


María de la Paz Casas, Fernando García, Carolina Freyre-Carrillo, Natalia Montiel, Alberto de la Iglesia, Isabel Viciana, Ana Domínguez, Vicente Guillot, Aurora Muñoz, Purificación Cantudo, Francisco Franco-Álvarez, Juan Antonio Reguera, María Angustias Romera, Teresa Cabezas, Julio Vargas, Mercedes Ramírez-Arcos, Inmaculada Guerrero, África García-Navarrete, María Jesús Pérez-Santos, Encarnación Clavijo, Carolina Roldán, Antonio Guzmán, Matilde Palanca, Eva Torres, María del Carmen Serrano, María del Carmen Lozano, Berta Becerril, Pilar Luzón, María Ángeles Galán, Juan Carlos Alados, Federico García,

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.

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Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
© 2020 The Spanish Journal of Gastroenterology