Tao Yusha, Tang Weiming, Fajardo Emmanuel, Cheng Mengyuan, He Shiyi, Bissram Jennifer S, Hiebert Lindsey, Ward John W, Chou Roger, Rodríguez-Frías Francisco, Easterbrook Philippa, Tucker Joseph D
Dermatology Hospital of South Medical University, Guangzhou, China.
University of North Carolina Project-China, Guangzhou, China.
Clin Infect Dis. 2023 Oct 13;77(8):1137-1156. doi: 10.1093/cid/ciad126.
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.
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.
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.
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.
PROSPERO CRD42021283822.
许多丙型肝炎病毒（HCV）抗体（Ab）检测呈阳性的人从未接受过HCV RNA病毒载量（VL）的确诊检测。即时检测VL可能有助于解决这一问题。我们进行了一项系统评价，以评估即时检测VL与标准非即时检测方法相比，在整个HCV治疗过程中的效果。
我们检索了4个数据库，查找研究基于实验室的即时或基于诊所的即时VL检测方法的研究，无论是否有非即时检测对照，且有关于HCV RNA VL检测的接受情况、治疗启动情况以及Ab检测和VL检测之间周转时间的数据。基于实验室和基于诊所的即时VL检测都只需要一次门诊就诊。使用随机效应荟萃分析计算汇总估计值。
纳入了51项研究（32项基于实验室的即时VL检测和19项基于诊所的即时VL检测）。与非即时检测相比，基于实验室的即时VL检测增加了HCV VL检测的接受率（RR：1.35；95%CI：1.16 - 1.58），并且可能改善HCV RNA检测呈阳性者的护理衔接（RR：1.47；95%CI：0.81 - 2.67）以及HCV治疗启动情况（RR：1.03；95%CI：0.46 - 2.32）。所有基于实验室的即时检测研究中，Ab检测和VL检测之间的中位时间<1天，13项基于诊所的即时检测中为0 - 5天。
基于实验室和基于诊所的HCV即时VL检测增加了接受率，缩短了HCV VL检测时间，并且可能增加HCV护理衔接。世界卫生组织现在推荐即时VL检测作为促进HCV VL检测和治疗可及性的一项额外策略。
PROSPERO CRD42021283822。
