Survey to Evaluate the Implementation of the Recommendations on the Comprehensive Diagnosis of Viral Hepatitis in a Single Extraction: Where Are We?

Author: Joaquin Cabezas, Antonio Aguilera, Marina Berenguer, María Buti, María Eliecer Cano, Xavier Forns, Federico Garcia, Javier García-Samaniego, Manuel Hernández-Guerra, Francisco Jorquera, Jeffrey V. Lazarus, Sabela Lens, Elisa Martró, Juan Antonio Pineda, Martin Prieto, Francisco Rodríguez-Frías, Manuel Rodriguez, Miguel Ángel Serra, Juan Turnes, Raquel Domínguez-Hernández, Nerea Tejado Alsua, Araceli Casado Gómez, Miguel Ángel Casado, José Luis Calleja, Javier Crespo

Theme: Clinical Research Year: 2023

Several Spanish Associations agreed to release a document in 2022 to carry out a comprehensive diagnosis of viral hepatitis (B, C and D) [doi: 10.1111/liv.15529]: a positive result in serology to detect viral hepatitis (HBV, HCV and HDV), as well as HIV, would trigger the analysis of the rest of the virus, including viral load, from the same blood sample. This would improve linkage to care. Aim: To evaluate the situation in Spain regarding the comprehensive diagnosis of viral hepatitis in a single blood draw.

A panel of experts prepared a structured digital survey with Google Forms platform to all Spanish hospitals, public or private with teaching accreditation, with 200 beds or more.

Of the 130 hospitals with inclusion criteria, 79 responded (61%). All centers have tools for the determination of HBV surface antigen, anti-HCV and HIV serology. 92% have a PCR technique for HBV/HCV. Only 63% of the centers can detect anti-HDV, and 28% can perform HDV-RNA; Point-of-Care tests availability is low(24%): GenXpert HCV(58%) and dry blood spot(47%). Reflex-test diagnosis is performed simultaneously in 99% of centers for HCV, 70% for HBV, 48% for HDV, and only 44% for HBV-HDV. Although 91% of centers believe that HBV/HCV serology should be performed on HIV-positive patients in the same sample, it is only done on 33-38%. Active infections are automatically communicated in 77% (100% hospitals for HCV, 49%-HBV and 31%-HDV). The automated appointment is only available in 20% of the centers.

Although most hospitals can carry out a comprehensive diagnosis of viral hepatitis in a single analytical sample, this is used in less than 50% of cases for HBV/HDV. Alerts to maintain continuity of care are widely available for hepatitis C, need to be increased for HBV and HDV. Likewise, it is necessary to implement decentralized diagnosis.

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