Point-of-Care Testing Increases HCV Treatment Uptake in Priority Settings in Australia

The implementation of hepatitis C virus (HCV) antibody and RNA point-of-care (POC) testing increases testing rates, treatment uptake, and linkage to care among patients in mental health, prison, and drug and alcohol facilities, according to study results published in Clinical Infectious Diseases.

Researchers conducted a prospective interventional cohort study between October 2020 and December 2021 to assess the effect of HCV antibody and RNA POC testing among patients in a reception prison, alcohol and other drug inpatient unit, and an inpatient mental health service in Australia. Adult patients who were not currently receiving HCV treatment were eligible for inclusion. Data pertaining to demographics, previous HCV testing history, and patient attitudes toward HCV POC testing were collected via survey. The primary outcomes were the number and proportion of patients who underwent HCV antibody and RNA POC testing, were linked to care, and commenced treatment. A rate ratio [RR] was calculated for both antibody and RNA testing to assess for changes in testing rates between the intervention and historical control periods. Differences in treatment uptake between the periods were assessed via Fisher exact testing.

A total of 1549 patients (median age, 37 [IQR, 30-46] years; men, 83%; Aboriginal/Torres Strait Islander, 25%; previously underwent HCV testing, 54%) were enrolled in the study. Overall, 264 (17%) patients tested HCV antibody-positive, 100% of whom received reflexive RNA testing. There were 55 patients who tested positive for both HCV RNA and HCV antibodies, of whom 29 (53%) reported experiencing homelessness within 90 days of testing. Of note, the rate of chronic HCV infection across the total patient population was low (4%).

Most patients (98%) preferred same-day HCV POC testing over standard venipuncture and laboratory-based testing. In addition, most patients (84%) stated it was important to receive same-day results.

There was nearly a 3-fold increase in annual HCV antibody testing rates observed across all 3 study sites between the intervention period and historical control period (RR, 2.57; 95% CI, 2.32-2.85). Stratified by study site, there was approximately a 2-fold increase in testing rates in the mental health facility (RR, 1.88; 95% CI, 1.48-2.41) and in the reception prison (RR, 2.01; 95% CI, 1.77-2.30), with the highest increase observed in the alcohol and other drug facility (RR, 8.86; 95% CI, 6.67-11.99).

Further analysis between the intervention and historical control periods showed increases in HCV RNA testing rates across all 3 study sites (RR, 1.62; 95% CI, 1.31-2.01). However, the increase in testing was predominantly observed in the alcohol and other drug facility (RR, 5.68; 95% CI, 3.33-10.34) as opposed to the reception prison (RR, 1.25; 95% CI, 0.96-1.65) and the mental health service (RR, 0.72; 95% CI, 0.36-1.38). The researchers noted an overall reduction in the rate of HCV RNA positivity from the historical control period to the intervention period (from 33% to 21%).

Of the 55 patients who tested positive for HCV RNA, 91% were linked to care and 86% initiated treatment. The median time from referral to treatment initiation was 14 days.

Study limitations include the absence of demographic and clinical characteristics for the historical control group, interruptions caused by the COVID-19 pandemic, and the inability to measure uptake of HCV POC testing.

“Homelessness was a significant factor prohibiting linkage to care and HCV treatment and as such remains an area of need for further models of care to be developed within the community,” the researchers concluded.

By Janelle Barowski

References:

McCartney EM, Ralton L, Dawe J, et al; on behalf of the EC Australia partnership. Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities – the prompt study. Clin Infect Dis. Published online March 21, 2024. doi:10.1093/cid/ciae155

Source: Infectious Disease Advisor