Year 2026 / Volume 118 / Number 1
Original
From recommendations to practice ‒ Tracking the national rollout of comprehensive hepatitis diagnosis in Spain

4-13

DOI: 10.17235/reed.2025.11496/2025

Joaquín Cabezas, Antonio Aguilera, Federico García García, Raquel Domínguez-Hernández, Araceli Casado Gómez, Nataly Espinoza-Cámac, Miguel Ángel Casado, Javier Crespo, María Jesús Alcaraz Soriano on behalf of Task Force Spanish Group for Comprehensive Hepatitis Diagnosis*,

* Task Force Spanish Group for Comprehensive Hepatitis Diagnosis: María Jesús Alcaraz Soriano, Sonia Algarate Cajo, Roberto Alonso Fernández, Maitane Aranzamendi Zaldumbide, Marta Arias Temprano, Ricardo Manuel Arcay Barral, Ana Arribi Vilela, Teresa Arroyo Serrano, Raquel Baluja Pino, Berta Becerril Carral, Rafael Benito Ruesca, Samuel Bernal Martínez, Miriam Blasco Alberdi, Ana Blázquez Abellán, Teresa Cabezas Fernández, Rainer Campo Ramos, María Eliecer Cano García, Purificación Cantudo Muñoz, Laura Cardeñoso Domingo, Ángel Castaño Nuñez, Encarnación Clavijo Frutos, Rodolfo Copado Carretero, Sandra Cortizo Vidal, Alberto de la Iglesia Salgado, María Jesús del Amor Espín, Alberto Delgado Iribarren, Jose Luis Díaz de Tuesta del Arco, Felícitas Díaz-Flores Estévez, María del Carmen Domínguez Jiménez, Victoria Dominguez-Márquez, José María Eiros Bouza, Victoria Fernández Baca, Felipe Manuel Fernández Cuenca, Isabel Fernández Natal, Gema Fernández Rivas, Fernando Fernández Sánchez, Carolina Freyre Carrillo, Ignacio Gadea Gironés, Juan Carlos Galán Montemayor, Fernando García García, María Victoria García López, Sonsoles Garcinuño Pérez, Carmen Gómez González, Alejandro González Praetorius, María José Gude González, Maria Araceli Hernández Betancor, Juan Carlos Hurtado Negreiros, María Asunción Iborra Bendicho, María Magdalena Lara Pérez, María Josefa López de Goicoechea, María Fátima López Fabal, Jose Luis López Hontangas, María Dolores López Prieto, María del Carmen Lozano Domínguez, María Pilar Luzón García, María Dolores Maciá Romero, Yasmina Martín Martín, Olalla Martinez Macias, Ana Miqueleiz Zapatero, Luz Moldes Suárez, Laura Molina Esteban, Dolores Montero Vega, Natalia Montiel Quezel-Guerraz, Carmen Muñoz Almagro, María Navarro Aguirre, María Dolores Navarro Martínez, María Dolores Ocete Mochón, Valle Odero Bernal, Patricia Ordoñez Barrosa, Nieves Orta Mira, Diego Ortega Larrea, María Pilar Palacián Ruiz, María José Pena López, Ana Belén Pérez Jiménez, J. Alfredo Pérez Rivilla, Elisabeth Prieto Rodriguez, Andrés Quesada, Encarnación Ramirez de Arellano, Ariadna Rando Segura, Gabriel Reina González, Juan Carlos Rodríguez Díaz, Francisco Rodríguez Frías, Manuel Ángel Rodríguez Maresca, Luis Rodríguez Otero, Salud Rodríguez Pallares, María Mercedes Rodríguez Pérez, María Rodríguez Velasco, Susana Sabater Vidal, Ruth Sáez de la Maleta Úbeda, Maria Yolanda Salicio Bermejo, Mónica Sánchez Oñoro, Gemma María Sierra Dorado, Raquel Téllez Pérez, Luis Torres Sopena, Matilde Trigo Daporta, María Isabel Zamora Cintas

Abstract
Introduction: the comprehensive diagnosis of viral hepatitis is an advance towards its elimination, but not all Spanish hospitals performed this diagnosis in 2022. Our objective was to evaluate the situation of the comprehensive diagnosis after the publication of the guidelines and evaluate the degree of implementation in the centers that responded to both surveys. Methods: a descriptive cross-sectional study was conducted among 79 hospitals that had participated in the initial survey. They were reinvited to respond via Google Forms (sent 23/12/2024). Results: the response rate was 91 % (72/79). Compared to the previous year, reflex testing increased by 3 %, with notable increases for hepatitis B virus (HBV) (33 %), hepatitis C virus (HCV) (2 %), hepatitis D virus (HDV) (45 %) and dual HBV-HDV (79 %). Anti-HDV and HDV-RNA testing increased by 18 % and 21 %, respectively. Alerts to specialist physicians rose by 24.1 % for HBV and 52.9 % for HDV. Automated appointment systems and referral mechanisms also expanded. Hepatitis A virus (HAV) testing was integrated in 38 % of centers, human immunodeficiency virus (HIV) testing in 50 %, and sexually transmitted infections (STI) testing in 56 %. Conclusions: awareness and implementation of integrated diagnostics, particularly for hepatitis D, have improved. Nonetheless, further progress is needed to ensure broader coverage and to contribute towards World Health Organization (WHO) elimination goals.
Lay Summary
Diagnosing viral hepatitis from a single blood sample is a key step towards its elimination. In 2022, Spain published a set of national recommendations to support this strategy. However, the extent to which these recommendations had been adopted by hospitals was unclear. To address this, a second survey was conducted in early 2024 among the 79 hospitals that had participated in the first evaluation. A total of 72 hospitals responded (91%), and several improvements were observed compared to the previous year. More hospitals reported using comprehensive diagnostic approaches for hepatitis B, C and D. The number of centers performing hepatitis D testing in-house increased, as did the use of reflex testing to detect hepatitis D in patients with hepatitis B. Importantly, more centers reported that positive test results for hepatitis B, C or D were being automatically communicated to specialist physicians. Some hospitals also implemented automated appointment systems for follow-up care. In cases of hepatitis B or C, testing for hepatitis A and HIV was more frequently performed. In patients suspected of having a sexually transmitted infection (STI), HIV testing and full viral hepatitis screening were also more common. These findings suggest that Spanish hospitals are increasingly aware of the importance of integrated diagnostic strategies for viral hepatitis, including hepatitis D. Continued efforts are needed to ensure wider adoption and to help achieve national and international goals for hepatitis elimination.
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Cabezas J, Aguilera A, García García F, Domínguez-Hernández R, Casado Gómez A, Espinoza-Cámac N, et all. From recommendations to practice ‒ Tracking the national rollout of comprehensive hepatitis diagnosis in Spain. 11496/2025


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Publication history

Received: 15/07/2025

Accepted: 31/07/2025

Online First: 29/09/2025

Published: 14/01/2026

Article Online First time: 76 days

Article editing time: 183 days


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