Novel Implementation of Hepatitis B to Hepatitis Delta Reflex Testing in a United States Healthcare System.
Academic Article
Overview
abstract
OBJECTIVES: Hepatitis delta virus (HDV) is the most aggressive form of viral hepatitis, yet screening rates in the United States are low, and few institutions have attempted interventions to improve the screening cascade. We assessed barriers to reflex test implementation, including lack of an FDA-approved reflex test, and implemented hepatitis B surface antigen (HBsAg) to HDV antibody (HDV Ab) reflex testing in our large, urban, academic healthcare system. METHODS: We evaluated outcomes one year after implementation using summary statistics. Patient- and clinic-level characteristics were investigated for association with receiving a reflex test versus standalone using multivariable logistic regression. RESULTS: All patients with a reflex order and HBsAg-positive result received HDV Ab follow-up testing, and their time to HDV Ab result was significantly shorter than for those whose HDV test required a separate order (2 versus 11 days, p < 0.0001). Uptake of the reflex order was highest in primary care, where it was embedded into existing workflows. CONCLUSIONS: Reflex testing improved efficiency and reduced gaps in the HBsAg to HDV screening cascade. Disparities in reflex testing rates among different patient groups were found, highlighting the need for universal reflex testing.
