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- Title
Hepatitis C diagnostic management gap in Pakistan-Clinicians' knowledge impacting public health.
- Authors
Naseer, Fouzia; Mukhtar, Ana; Ahmed, Altaf; Raza, Afsheen
- Abstract
Aim: Hepatitis C virus (HCV) infects 10 million people in Pakistan with a prevalence rate of 4.9 %. Methods commonly used to diagnose HCV include anti-HCV and HCV RNA testing. However, HCV RNA is a molecular test that aims to identify active infection and is a test indicated for monitoring disease progression during therapy, while anti-HCV is a screening tool for detecting the presence of a virus in the body. Furthermore, liver function tests are part of routine testing in cases to assess the extent of liver damage. However, many clinicians in Pakistan are utilizing molecular tests to screen and diagnose HCV. Furthermore, elevated liver function test values are being justified for direct utilization of molecular tests instead of opting for anti-HCV tests. As HCV RNA tests detect only active infection and LFT values can be elevated or decreased because of other infections, using the HCV RNA test as a screening tool may have implications for patient management. Therefore, the main objective of this study was to evaluate clinicians' perspectives for HCV test-based diagnostic management and identify the quality gap with respect to the utility of molecular tests. Subjects and Methods: A retrospective, cross-sectional study was conducted analyzing medical records of patients coming to the gastroenterology outpatient department (OPD) of The Indus Hospital Laboratory, Karachi, Pakistan, during January 2014-2015. The study included patients in whom HCV RNA testing was performed. Both positive and negative HCV RNA groups were further analyzed to determine whether HCV antibody and liver function testing had been performed for the respective patients. The diagnostic management quality gap was identified on the basis of clinicians' perspectives with respect to the International Centers for Disease Control and Prevention (CDC) diagnostic guidelines. Results: A total of 1758 patients with HCV RNA testing were included in the study. Of these, 17.5 % of the patients had been tested for LFT only with direct testing for HCV RNA. In both the HCV RNA-positive (56 %) and -negative groups (44 %), the following discrepancies in diagnostic management were observed-the anti-HCV test was not performed in 51 and 62 % of the patients in the positive and negative HCV RNA group, respectively. Furthermore, 9.6 and 36 % of the HCV RNA-negative and -positive groups had not been evaluated for liver function tests and anti-HCV prior to molecular testing. Conclusion: Diagnostic management of HCV in Pakistan is compromised as clinicians utilize molecular testing as a screening tool rather than using the international guideline for utilizing anti-HCV for the diagnosis of HCV. Furthermore, the results of the liver function tests are being used to justify the generation of molecular tests. This practice is an important parameter in the diagnostic and disease management of HCV in Pakistan and requires robust clinician awareness at the national level.
- Subjects
PAKISTAN; HEPATITIS C diagnosis; PUBLIC health; ACADEMIC medical centers; HEPATITIS viruses; IMMUNOENZYME technique; LIVER function tests; PROFESSIONS; RNA; VIRAL antibodies; RETROSPECTIVE studies; DATA analysis software; PHYSICIANS' attitudes; DESCRIPTIVE statistics; TERTIARY care
- Publication
Journal of Public Health (09431853), 2016, Vol 24, Issue 4, p299
- ISSN
0943-1853
- Publication type
Article
- DOI
10.1007/s10389-016-0725-8