{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:02:22Z","timestamp":1792119742179,"version":"4.4.0"},"reference-count":59,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T00:00:00Z","timestamp":1693440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20131.58) and may improve linkage to care among people with a positive HCV RNA test (RR: 1.47; 95% CI: .81\u20132.67) and HCV treatment initiation (RR: 1.03; 95% CI: .46\u20132.32). The median time between Ab and VL test was &amp;lt;1 day for all laboratory-based reflex studies and 0\u20135 days for 13 clinic-based reflex testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>PROSPERO CRD42021283822.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciad126","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T12:54:45Z","timestamp":1678107285000},"page":"1137-1156","source":"Crossref","is-referenced-by-count":31,"title":["Reflex Hepatitis C Virus Viral Load Testing Following an Initial Positive Hepatitis C Virus Antibody Test: A Global Systematic Review and Meta-analysis"],"prefix":"10.1093","volume":"77","author":[{"given":"Yusha","family":"Tao","sequence":"first","affiliation":[{"name":"Dermatology Hospital of South Medical University , Guangzhou ,","place":["China"]},{"name":"University of North Carolina Project\u2013China , Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiming","family":"Tang","sequence":"additional","affiliation":[{"name":"Dermatology Hospital of South Medical University , Guangzhou ,","place":["China"]},{"name":"University of North Carolina Project\u2013China , Guangzhou ,","place":["China"]},{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Fajardo","sequence":"additional","affiliation":[{"name":"Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyuan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Dermatology Hospital of South Medical University , Guangzhou ,","place":["China"]},{"name":"University of North Carolina Project\u2013China , Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyi","family":"He","sequence":"additional","affiliation":[{"name":"China\u2013Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S","family":"Bissram","sequence":"additional","affiliation":[{"name":"Health Sciences Library, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Hiebert","sequence":"additional","affiliation":[{"name":"Coalition for Global Hepatitis Elimination, Task Force for Global Health , Decatur, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Ward","sequence":"additional","affiliation":[{"name":"Coalition for Global Hepatitis Elimination, Task Force for Global Health , Decatur, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Chou","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University , Portland, Oregon ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Rodr\u00edguez-Fr\u00edas","sequence":"additional","affiliation":[{"name":"Liver Pathology Unit, Biochemistry and Microbiology Service, Hospital Universitari Vall d'Hebron , Barcelona ,","place":["Spain"]},{"name":"CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Easterbrook","sequence":"additional","affiliation":[{"name":"Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2804-1181","authenticated-orcid":false,"given":"Joseph D","family":"Tucker","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013China , Guangzhou ,","place":["China"]},{"name":"Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina ,","place":["USA"]},{"name":"Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , London ,","place":["United 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care practices serving disadvantaged populations","volume":"171","author":"Turner","year":"2019","journal-title":"Ann Intern Med"},{"key":"2024111411420059800_ciad126-B28","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.jhep.2019.11.019","article-title":"Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia","volume":"72","author":"Averhoff","year":"2020","journal-title":"J Hepatol"},{"key":"2024111411420059800_ciad126-B29","first-page":"515","article-title":"Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia","volume":"112","author":"Casas","year":"2020","journal-title":"Rev Esp Enferm Dig"},{"issue":"Suppl 5","key":"2024111411420059800_ciad126-B30","doi-asserted-by":"crossref","first-page":"S335","DOI":"10.1093\/infdis\/jiz686","article-title":"Hepatitis C virus (HCV) care continuum outcomes and HCV community viral loads among patients in an opioid treatment 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reflex HCV core antigen tests in the remote communities of a resource-rich setting: a population-based prospective cohort study","volume":"11","author":"Chang","year":"2021","journal-title":"BMJ Open"},{"key":"2024111411420059800_ciad126-B34","doi-asserted-by":"crossref","first-page":"719","DOI":"10.5811\/westjem.2021.1.49667","article-title":"Universal screening for hepatitis C virus in the ED using a best practice advisory","volume":"22","author":"Ford","year":"2021","journal-title":"West J Emerg Med"},{"key":"2024111411420059800_ciad126-B35","doi-asserted-by":"crossref","first-page":"136","DOI":"10.3350\/cmh.2020.0150","article-title":"Scaling up the in-hospital hepatitis C virus care cascade in Taiwan","volume":"27","author":"Huang","year":"2021","journal-title":"Clin Mol Hepatol"},{"key":"2024111411420059800_ciad126-B36","doi-asserted-by":"crossref","first-page":"114039","DOI":"10.1016\/j.jviromet.2020.114039","article-title":"Reflex viral load testing in dried blood spots 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