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BARRIERS TO HEPATITIS DELTA SCREENING: THE POINT OF VIEW OF FRENCH BIOLOGISTS
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AASLD 2022 Nov 4-8
Myrianne Bernardin1, Sonia Burrel2, Gerard Lina3, Celine Rigaud4, Sandrine Francois5, Laurent Andreoletti6, Sophie Alain4, Veronique Loustaud- Ratti4 and the French Society of Microbiology, (1) Limoges University, (2)AP- HP, (3)Hospices Civils De Lyon, (4)Limoges University Hospital, (5)Department Hepatogastroenterology, Centre Hospitalier Universitaire ŕ Limoges, Limoges, France, (6)Reims University Hospital
Program Abstract
Background: Knowledge of the prevalence of delta hepatitis (HDV) in France is based on figures either from HBsAg + target populations or from expert centers. The difficulties to access to virological screening techniques could be one of the factors of underestimation. We there-fore conducted, under the aegis of the French Society of Microbiology (SFM), a flash survey of the practice of delta tests from the biologist's point of view.
Methods: A questionnaire comprising 14 items was sent to members of the SFM. The questions focused on subcontracting, reflex testing and virological techniques used in partic-ular for RT- PCR.
Results: 131 laboratories responded: 36 university hospital centers (UHC), 53 non- university hospital centers (HC), 42 private laboratories (PL). Apart from the delta national reference center (CNR) and Cerba and Eurofins/Biomnis groups (main PL in France) which receive the majority of delta antibodies (Ab) tests for outsourcing, 26 laboratories (20%) carry out delta Ab on site, 24 UHC and 2 PL; 10 UHC and 1 PL practice HDV RT- PCR on site. 64% of laboratories that do not perform delta Ab, do not plan to perform them in the future and 79% for HDV RT- PCR. A majority of the Ab requested are subcontracted by Cerba (34.2%) and Eurofins (37.2%) or by other PL (12%), the CNR (7.5%) and 7 university hospitals (9%). The RT- PCR are subcontracted by the CNR (42.3%), the UHC of Lyon (22.7%), Cerba (16%), Eurofins (15.2%), other PL (2.2 %) and 3 other UHC (1.7%). The reflex testing for delta Ab when a first HBsAg+ test is identified, is performed by 23% of laboratories and 11% for RNA in case of delta Ab+; 45% are considering it for Ab and 14% for RNA, subject to test reimbursement. RT-P CR techniques used are a commercial Eurobioplex® kit for 73% and an in- house technique for 27%. A real-l ife survey ("Delta Describe") on the prescription of screening tests and on the patient care is underway: one part will be based on French medical insurance data and the other, on patients' data tested positive in French metropolitan laboratories.
Conclusion: A majority of French laboratories outsource delta testing and less than 20% practice reflex testing. "Delta Describe", under the aegis of learned so-cieties (Hepatology, Infectiology and Microbiology) and patient associations, should help to provide the DGS/DGOS (Directorate General for Healthcare) and HAS (High Authority for Health) with solutions to barriers identified to screening and to the cascade of real life care.
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