Abstract Background In 2019 and 2020, universal hepatitis C screening of adults was recommended by clinical guideline authorities, including the Centers for Disease Control and Prevention (CDC). In 2023, CDC recommendations emphasized the importance of reflexive hepatitis C testing in which samples positive for hepatitis C virus (HCV) antibody (Ab) automatically reflex to viral RNA nucleic acid amplification testing (NAAT). Laboratory stewardship initiatives to guide compliance with expanded guidelines were implemented. Methods We conducted a retrospective review of 38,233,788 specimens with HCV Ab testing and 1,423,543 follow up HCV RNA NAAT tests performed from 2018 to 2024 to evaluate the impact of expanded hepatitis C guidelines and laboratory stewardship initiatives. Results From 2018 to 2024, reflexive hepatitis C testing volumes increased annually while orders for standalone HCV Ab testing and HCV Ab positivity rates steadily declined. Among HCV Ab positive individuals, the percentage with reflexive testing increased from 21.9% in 2018 to 82.2% in 2024 (Ƭ=1.00, p=0.003) and RNA testing rates increased from 66.4% in 2018 to 89.3% in 2024 (Ƭ=1.00, p=0.003). Follow up RNA testing was increasingly completed earlier in HCV Ab positive individuals with the same day RNA testing rate increasing from 38.0% in 2018 to 82.2% in 2024. HCV RNA positivity decreased 19.2% during the study period. Conclusions Expanded hepatitis C screening guidelines highlighting the importance of reflexive HCV testing and subsequent internal laboratory stewardship initiatives likely contributed to the increased utilization of reflexive hepatitis C testing and the decreased time to identification of active hepatitis C infection.
Lee et al. (Tue,) studied this question.