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Abstract Details
Reflex Hepatitis C Virus Viral Load Testing Following an Initial Positive Hepatitis C Virus Antibody Test: A Global Systematic Review and Meta-analysis
Clin Infect Dis. 2023 Oct 13;77(8):1137-1156. doi: 10.1093/cid/ciad126.
1Dermatology Hospital of South Medical University, Guangzhou, China.
2University of North Carolina Project-China, Guangzhou, China.
3Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
4Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland.
5China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
6Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
7Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA.
8Departments of Medicine and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.
9Liver Pathology Unit, Biochemistry and Microbiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
10CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain.
11Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Abstract
Background: Many people who have a positive hepatitis C virus (HCV) antibody (Ab) test never receive a confirmatory HCV RNA viral load (VL) test. Reflex VL testing may help address this problem. We undertook a systematic review to evaluate the effectiveness of reflex VL testing compared with standard nonreflex approaches on outcomes across the HCV care cascade.
Methods: We searched 4 databases for studies that examined laboratory-based reflex or clinic-based reflex VL testing approaches, with or without a nonreflex comparator, and had data on the uptake of HCV RNA VL test and treatment initiation and turnaround time between Ab and VL testing. Both laboratory- and clinic-based reflex VL testing involve only a single clinic visit. Summary estimates were calculated using random-effects meta-analyses.
Results: Fifty-one studies were included (32 laboratory-based and 19 clinic-based reflex VL testing). Laboratory-based reflex VL testing increased HCV VL test uptake versus nonreflex testing (RR: 1.35; 95% CI: 1.16-1.58) and may improve linkage to care among people with a positive HCV RNA test (RR: 1.47; 95% CI: .81-2.67) and HCV treatment initiation (RR: 1.03; 95% CI: .46-2.32). The median time between Ab and VL test was <1 day for all laboratory-based reflex studies and 0-5 days for 13 clinic-based reflex testing.
Conclusions: Laboratory-based and clinic-based HCV reflex VL testing increased uptake and reduced time to HCV VL testing and may increase HCV linkage to care. The World Health Organization now recommends reflex VL testing as an additional strategy to promote access to HCV VL testing and treatment.