Inovações Tecnológicas no Rastreio e Diagnóstico da Hepatite C: Revisão Focada de Literatura
DOI:
https://doi.org/10.24950/rspmi.2175Palavras-chave:
Hepatite C/diagnóstico, Hepatite C Crónica/diagnóstico, Hepatite Viral, Sistemas Point-of-CareResumo
Introdução: A norma de avaliação diagnóstica da infeção
pelo vírus da hepatite C em Portugal (2017) limita a confirmação de testes de anticorpo positivos a consultas
especializadas em meio hospitalar, com testes moleculares.
Outros profissionais, entidades prestadoras ou tecnologias não são contemplados, apesar das inovações que permitiriam um atendimento mais centrado na pessoa.
Métodos: Realizámos uma revisão focada de literatura
publicada entre 2011 e 2021 sobre o diagnóstico reflexo
(em que a confirmação de anticorpo positivo é efetuada no
espécimen inicial) ou num-só-passo, o teste de antigénio
core e os testes moleculares point-of-care.
Resultados: Incluímos um total de 44 artigos relevantes,
na sua maioria originários de Espanha e dos Estados Unidos da América.
Discussão: O diagnóstico reflexo demonstrou aumentar
a proporção de indivíduos sujeitos a confirmação de viremia, o custo-eficácia do rastreio, a ligação com os cuidados de saúde e o início de tratamento. O antigénio core demonstrou ser aceitável como alternativa aos métodos moleculares para fins confirmatórios, com custos e tempos de processamento mais baixos (70% e 85% respetivamente). Os testes moleculares point-of-care permitem a descentralização do rastreio na comunidade, com uma infraestrutura e conhecimentos técnicos requeridos mínimos. Embora subsistam preocupações quanto ao custo das soluções point-of-care, disponibilizá-las permitiria aos serviços que cuidam de populações em risco acrescido realizar testes confirmatórios em tempo útil e aumentar a ligação aos cuidados de saúde.
Conclusão: Há uma forte evidência que apoia o diagnóstico
reflexo como padrão para o rastreio em todos os
serviços de saúde. O uso de testes confirmatórios de antigénio core ou de testes moleculares point-of-care também deve ser considerado em contextos apropriados.
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