Hepatitis C Reflex Testing
To ensure complete and timely diagnosis of HCV, HCV reflex testing is recommended following a reactive hepatitis C antibody screening test. Reflex testing means the laboratory will perform the hepatitis C antibody test, and if the result is positive, the laboratory will immediately perform an HCV RNA test on the same specimen. If the subsequent HCV RNA test is negative, HCV infection is effectively ruled out for most patients. If the reflex HCV RNA test is positive, a diagnosis of active HCV infection has been confirmed, and the individual should be referred directly for HCV care and treatment.
Reflex testing obviates the need for the patient to return for follow-up testing should the initially HCV antibody test be reactive. If the RNA test is negative, the work-up is done, and the patient may be reassured.
- CDC Guidance on HCV Reflex Testing, July 13, 2023
- HCV Reflex Testing Dear Colleague Letter: The purpose of this letter is to provide information to all clinicians and lab directors on HCV reflex testing as a method for ensuring timely HCV diagnosis and linkage to care.
- Validating HCV Quantitative assays for reflex testing - NYSDOH CLEP guidance to labs
- NYSDOH Medicaid reimbursement of reflex testing
- CDC Hepatitis C Testing Guidance for Clinicians and Laboratories
- CDC testing algorithm
- CDC lab interpretation table
- Commercial lab information on reflex testing
- Hepatitis C Testing - Name badge card.
- Rationale for reflex testing:
- CDC. Viral Signs - Evaluation of Hepatitis C Virus Infection Testing and Reporting — Eight U.S. Sites, 2005–2011. MMWR / May 10, 2013 / Vol. 62 / No. 18.
- Hirsch A, et. al. Implementation and evaluation of a multicomponent quality improvement intervention to improve efficiency of hepatitis C screening and diagnosis. The Joint Commission Journal on Quality and Patient Safety. 2014, Aug14; 40(8):351-357.
- McGibbon E, et. al. Half a Diagnosis: Gap in Confirming Infection among Hepatitis C Antibody-positive Patients. Am J Med. 2013 Aug;126(8):718-22