Publicação
Technological Innovations in Hepatitis C Screening and Diagnosis: Focused Literature Review
| Resumo: | Introduction: Current Portuguese hepatitis C virus (HCV)screening guidance (2017) limits confirmation of antibody--positive test results to hospital specialist visits, using nucleic acid amplification tests (NAAT). No other professionals, healthcare settings, or testing technologies are included, despite innovations toward more patient-centric care. Methods: We performed a focused review of literaturepublished between 2011 and 2021 regarding reflex (in which confirmation of antibody-positive test is done on the initial serum specimen) or single-step testing, HCV core antigen (cAg), and point-of-care (POC) HCV NAAT. Results: We incorporated a total of 44 relevant papers,mostly from Spain and the United States of America. Discussion: Reflex testing workflows have consistentlybeen shown to increase completion of confirmatory testing,screening program cost-effectiveness, patient linkageto care, and treatment initiation. HCV cAg determinationhas also been established as an acceptable alternative toNAAT for confirmatory testing, with lower cost and lowerturnaround time (70% and 85% respectively). Lastly, POCHCV NAAT enables decentralized screening in communitysettings, with minimal infrastructure and technical expertiserequired. Although concerns remain regarding the cost ofPOC NAAT solutions, their availability is crucial in empowering facilities caring for at-risk populations to perform timely confirmatory testing and increase patient linkage to care and treatment. Conclusion: There is a strong body of evidence to supportreflex testing as the standard of care for HCV screeningin all healthcare settings. HCV cAg or POC HCV NAATconfirmatory testing should also be supported where appropriate, in alternative to strictly central laboratory-based HCV NAAT. |
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| Autores principais: | Botto, Inês |
| Outros Autores: | Rodrigues, Inês; Bronze, Sérgio; Medina, Diogo; Freire, Rita; Serejo, Fátima |
| Assunto: | Hepatite C/diagnóstico Hepatite C Crónica/diagnóstico Hepatite Viral Sistemas Point-of-Care Hepatitis C/diagnosis Hepatitis C, Chronic/ diagnosis Hepatitis, Viral, Human Point-of-Care Systems |
| Ano: | 2024 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | unknown |
| Instituição associada: | Sociedade Portuguesa de Medicina Interna |
| Idioma: | português |
| Origem: | Revista Portuguesa de Medicina Interna |
| Resumo: | Introduction: Current Portuguese hepatitis C virus (HCV)screening guidance (2017) limits confirmation of antibody--positive test results to hospital specialist visits, using nucleic acid amplification tests (NAAT). No other professionals, healthcare settings, or testing technologies are included, despite innovations toward more patient-centric care. Methods: We performed a focused review of literaturepublished between 2011 and 2021 regarding reflex (in which confirmation of antibody-positive test is done on the initial serum specimen) or single-step testing, HCV core antigen (cAg), and point-of-care (POC) HCV NAAT. Results: We incorporated a total of 44 relevant papers,mostly from Spain and the United States of America. Discussion: Reflex testing workflows have consistentlybeen shown to increase completion of confirmatory testing,screening program cost-effectiveness, patient linkageto care, and treatment initiation. HCV cAg determinationhas also been established as an acceptable alternative toNAAT for confirmatory testing, with lower cost and lowerturnaround time (70% and 85% respectively). Lastly, POCHCV NAAT enables decentralized screening in communitysettings, with minimal infrastructure and technical expertiserequired. Although concerns remain regarding the cost ofPOC NAAT solutions, their availability is crucial in empowering facilities caring for at-risk populations to perform timely confirmatory testing and increase patient linkage to care and treatment. Conclusion: There is a strong body of evidence to supportreflex testing as the standard of care for HCV screeningin all healthcare settings. HCV cAg or POC HCV NAATconfirmatory testing should also be supported where appropriate, in alternative to strictly central laboratory-based HCV NAAT. |
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