Diagnostic gaps in HCV RNA testing in the era of elimination: a single-center study

Abstract

Introduction: It is essential to identify the current gaps in order to reach hepatitis C virus (HCV) elimination. This study focused on detecting undiagnosed HCV cases, to assess clinic awareness levels in the diagnostic process and explore strategies to decrease the number of undiagnosed cases.

Methodology: Anti-HCV seropositive patients identified at the hospital between 1 January 2022, and 31 December 2023, were retrospectively reviewed. Anti-HCV seropositive patients who did not have an HCV ribonucleic acid (RNA) test done were invited to the hospital, and those who came underwent HCV RNA testing.

Results: A total of 78,769 anti-HCV tests were conducted at the hospital, with 555 patients (0.7%) testing positive. HCV RNA testing was requested for 307 (55.3%) of the anti-HCV-positive patients during follow-up visits. The rate of HCV RNA test requests among anti-HCV-positive patients was significantly lower in surgical clinics compared to other clinics that requested HCV RNA testing (p < 0.001). Telephone calls were made to 248 patients who had not undergone HCV RNA testing, of whom 114 (46%) could not be reached. An anti-HCV signal-to-cutoff ratio (S/Co) ratio above 10.38 demonstrated 100% sensitivity and 89% specificity in predicting HCV RNA positivity (AUC: 0.95, p < 0.001).

Conclusions: Raising awareness among surgical clinics about HCV diagnosis and developing reflex testing algorithms to enable diagnosis at the patient's first hospital visit will significantly support efforts to eliminate HCV.