CHALLENGES IN DELIVERY OF POINT OF CARE TESTING FOR HCV RNA IN A MOBILE HEALTH SERVICE FOR PEOPLE WHO INJECT DRUGS (PWID)


Author: Thingnes G, Ulstein K, Dalgard O

Theme: Clinical Research Year: 2019

Background:
Models of care need continuous simplyfing in order to increase the treatment uptake among the
most marginalized PWID. Point of care (POC) test for HCV RNA has been shown to provide accurate
results within one hour enabling testing and prescription of treatment in one visit. The primary aim
of this study was to assess the utility of a point of care (POC) test for HCV in a mobile low threshold
health service.
Methods:
This is a prospective cohort study where POC test for HCV RNA was performed on capillary blood
(GeneXpert® HCV Viral Load, response time 1 hour) by “Nurses on Wheels” in Oslo, a mobile
outreach clinic for PWID. Users were first screened for anti-HCV antibodies with an oral swab
(OraQuick®, response time 20 minutes). Those who were antibody positive and went on to have a
POC test were included. Participants gave written informed consent.
Results:
We screened 46 users (mean age 38, range 20-59, 70% male) for anti-HCV antibodies. Twenty-five
patients (54 %) were positive (24% of those < 35 years) whereof none waited to have a POC performed. Within 8 weeks 8 patients were retrieved, included and had a POC test performed. Three had detectable HCV RNA. No patients waited at the service for the POC result but they were contacted afterwards. To date three have initiated HCV treatment. Conclusion: Difficulties in retaining patients at site after both antibody screening and POC testing greatly reduced the uptake to POC testing and made it impossible to profit from POC testing’s perhaps most important benefit of enabling testing and initiation of treatment in one visit. In our case this prompted an amendment to the protocol and hereafter all clients will be screened directly with the POC test. The challenge of retaining patients after the POC test remains. Disclosure of Interest Statement: GeneXpert® including test kits used in this study are donated by Bergmann Diagnostika.

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