Year 2020 / Volume 112 / Number 7
Original
Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia

515-519

DOI: 10.17235/reed.2020.6370/2019

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,

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.
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References
(1) Tapias MM, Idrovo CV. Historia natural. Rev Col Gastroenterol 2013;28(Suppl 1):4-6.
(2) Lavin AC, Perello C, Llerena S, et al. Prevalence of hepatitis C in the spanish population. The prevhep study (ethon cohort). J Hepatol 2017;66(Suppl 1):S272. DOI: 10.1016/S0168-8278(17)30857-7
(3) Aguinaga A, Díaz-González J, Pérez-García A, et al. The prevalence of diagnosed and undiagnosed hepatitis C virus infection in Navarra, Spain, 2014-2016. Enferm Infecc Microbiol Clin 2018;36(6):325-31. DOI: 10.1016/j.eimc.2016.12.008.
(4) Ministerio de Sanidad, Servicios Sociales e Igualdad. Plan estratégico para el abordaje de la hepatitis C en el sistema nacional de salud. Madrid, 21 de mayo de 2015. Avaliable from: https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/docs/plan_estrategico_hepatitis_C.pdf
(5) Hill AM, Nath S, Simmons B. The road to elimination of hepatitis C: analysis of cures versus new infections in 91 countries. J Virus Erad 2017;3(3):117-23.
(6) Gottwein JM, Pham LV, Mikkelsen LS, et al. Efficacy of NS5A Inhibitors Against Hepatitis C Virus Genotypes 1-7 and Escape Variants. Gastroenterology 2018; 154(5):1435-48. DOI: 10.1053/j.gastro.2017.12.015.
(7) Li G, De Clercq E. Current therapy for chronic hepatitis C: The role of direct-acting antivirals. Antiviral Res 2017;142:83-122. DOI: 10.1016/j.antiviral.2017.02.014.
(8) World Health Organization (WHO). Hepatitis C fact sheet. 2017. Consultado el 29 de enero de 2018. Available from: http://www.who.int/news-room/fact-sheets/detail/hepatitis-c
(9) Tsertsvadze T, Gamkrelidze A, Chkhartishvili N, et al. Hepatitis C care cascade in the country of Georgia after 2 years of starting national hepatitis C elimination program. Averhoff. J Hepatol 2018;68(Suppl 1):S53. DOI: 10.1016/S0168-8278(18)30326-X
(10) Tyrfingsson T, Runarsdottir V, Hansdottir I, et al. Marked reduction in the prevalence of hepatitis C viremia among people who inject drugs during 2nd year of the Treatment as Prevention (TraP HepC) program in Iceland. 1SAA. J Hepatol 2018;68(Suppl 1):53. DOI: 10.1016/S0168-8278(18)30325-8
(11) Buti M, Calleja JL, García-Samaniego J, et al. Eliminación de la Hepatitis C en España: Adaptación de un modelo matemático de salud pública partiendo del plan estratégico para el abordaje de la hepatitis C en el Sistema Nacional de Salud. Med Clin (Barc) 2017;148:277-82. DOI: 10.1016/j.medcli.2016.12.018
(12) Alonso R, Aguilera A, Córdoba J, et al. Microbiological diagnosis of viral hepatitis. Enferm Infecc Microbiol Clin 2015;33(9):e53-62. DOI: 10.1016/j.eimc.2014.08.002.
(13) Buti M, Domínguez-Hernández R, Casado MA, et al. Healthcare value of implementing hepatitis C screening in the adult general population in Spain. PLoS One 2018;13(11):e0208036. DOI: 10.1371/journal.pone.0208036
(14) Cuadrado A, Perello C, Llerena S, et al. Design and cost effectiveness of a hepatitis C virus elimination strategy based on an updated epidemiological study (ETHON Cohort, Epidemiological sTudy of Hepatic infectiONs). J Hepatol 2018;68 (Suppl 1):S164. DOI: 10.1016/S0168-8278(18)30540-3
(15) Grebely J, Lamoury FMJ, Hajarizadeh B, et al. Evaluation of the Xpert HCV Viral Load point-of-care assay from venepuncture-collected and finger-stick capillary whole-blood samples: a cohort study. Lancet Gastroenterol Hepatol 2017;2(7):514-20. DOI: 10.1016/S2468-1253(17)30075-4
(16) Harris M, Ward E, Gore C. Finding the undiagnosed: a qualitative exploration of hepatitis C diagnosis delay in the United Kingdom. J Viral Hepat 2016;23:479-86. DOI: 10.1111/jvh.12513
(17) Crespo J, Lázaro de Mercado P, Blasco Bravo AJ, et al. Diagnosis of hepatitis C virus infection in Spain: An opportunity to improve. Enferm Infecc Microbiol Clin 2019;37(4):231-8. DOI:10.1016/j.eimc.2018.05.016
(18) Alados JC, Casas MDLP, Cabezas T, et al. Situación actual del diagnóstico de la infección por virus de la Hepatitis C en Andalusia. Enferm Infecc Microbiol Clin 2017;35(Espec Cong 2):25-6
(19) Casas MDLP, García F, Costa JJ, et al. Diagnóstico del virus de la hepatitis c: impacto de la actitud del servicio de Microbiología en la cascada del tratamiento. Enferm Infecc Microbiol Clin 2017;35(Espec Cong 1):237.
(20) Assoumou SA, Tasillo A, Leff JA, et al. Cost-Effectiveness of One-Time Hepatitis C: Screening Strategies Among Adolescents and Young Adults in Primary Care Settings. Clin Infect Dis 2018;66(3):376-84. DOI: 10.1093/cid/cix798
(21) Lebovics E, Torres R, Porter LK. Primary Care Perspectives on Hepatitis C Virus Screening, Diagnosis and Linking Patients to Appropriate Care. Am J Med 2017;130(2):S1-S2. DOI: 10.1016/j.amjmed.2017.01.001
(22) Alados JC, Casado M, Téllez F, et al. Diagnóstico de la hepatitis c en un solo paso. Necesidades para contribuir a la eliminación en Andalucía. Revista de la sociedad andaluza de microbiología y parasitología clínica 2018;1:15-6
(23) Greenaway C, Azoulay L, Allard R, et al. A population-based study of chronic hepatitis C in immigrants and non-immigrants in Quebec, Canada. BMC Infect Dis 2017;17:140. DOI: 10.1186/s12879-017-2242-y
(24) Levi M, Falla A, Taddei C, et al. Referral of newly diagnosed chronic hepatitis B and C patients in six EU countries: results of the HEPscreen Project. Eur J Public Health 2016;26:561-69. DOI: 10.1093/eurpub/ckw054
(25) Grebely J, Larney S, Peacock A, et al. Global, regional, and country‐level estimates of hepatitis C infection among people who have recently injected drugs. Addiction 2019;114(1):150-66. DOI: 10.1111/add.14393
(26) Chevaliez S, Pawlotsky JM. How to use virological tools for optimal management of chronic hepatitis C. Liver Int 2009;29 (Suppl 1):9-14. DOI: 10.1111/j.1478-3231.2008.01926.x
(27) Arboledas JCA, Guerrero IP, Rodríguez MJB, et al. Hepatitis C virus core antigen in the management of patients treated with new direct-acting antivirals. Diagn Microbiol Infect Dis 2017;89(1):29-34. DOI: 10.1016/j.diagmicrobio.2017.06.006
(28) Van Tilborg M, Al Marzooqi SH, Wong WWL, et al. HCV core antigen as an alternative to HCV RNA testing in the era of direct-acting antivirals: retrospective screening and diagnostic cohort studies. Lancet Gastroenterol Hepatol 2018;3(12):856-64. DOI: 10.1016/S2468-1253(18)30271-1
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Casas M, García F, Freyre-Carrillo C, Montiel N, de la Iglesia A, Viciana I, et all. Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia. 6370/2019


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Publication history

Received: 05/05/2019

Accepted: 16/08/2019

Online First: 18/03/2020

Published: 08/07/2020

Article revision time: 100 days

Article Online First time: 318 days

Article editing time: 430 days


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